NPIMap

Organization Active NPI

Northlake Rehabilitation, LLC

  • Physical Therapist
  • Woodinville, WA
National Provider Identifier
1295919181
Registry record updated Dec 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
NORTHLAKE REHABILITATION, LLC
Practice address
18600 Woodinville Snohomish Rd NE
Woodinville, WA 98072-8531
Phone
(425) 488-6640
Fax
(425) 488-5424
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Tara L Urban
Title
Credentialing Coordinator
Phone
(425) 806-5721

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

18600 Woodinville Snohomish Rd NE
Woodinville, WA 98072-8531

Mailing address

18323 Bothell Everett Hwy Ste 220
Bothell, WA 98012-5246
Phone (425) 806-5700

Other identifiers 1

IdentifierTypeStateIssuer
7110141MedicaidWA

National Provider Directory

National Provider Directory

Locations

18600 Woodinville Snohomish Rd NE
Ste 220
Woodinville, WA 98072
Phone (425) 481-0494

18600 Woodinville Snohomish Rd NE
Woodinville, WA 98072
Phone (425) 488-6640

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1295919181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18323 BOTHELL EVERETT HWY STE 220",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980125246",
            "telephone_number": "425-806-5700",
            "fax_number": "425-806-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18600 WOODINVILLE SNOHOMISH RD NE",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980728531",
            "telephone_number": "425-488-6640",
            "fax_number": "425-488-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "URBAN",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "425-806-5721",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7110141",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodinville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.