Samantha Kidder, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

61175263 Issued in WA

Practice address

17012 Aurora Ave N Ste 101
Shoreline, WA 98133-5315

Phone

(205) 706-7500

NPI assigned

May 24, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prevail Practices PLLCGroup PAC ID 2163781634, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Prevail Practices, PLLC

  dba Prevail Physical Therapy

  • Physical Therapist
  • Shoreline, WA
  • NPI 1740723915
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1306411129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17012 AURORA AVE N STE 101",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17012 AURORA AVE N STE 101",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981335315",
            "telephone_number": "205-706-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "SAMANTHA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-24",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "61175263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Kessack
• David Ketola, LMHCA
• Kevin Lashinsky DDS PS
• Shahd Khalili-Sangsari, LMFTA
• Jennifer Khuu, PHARMD
• Menbere Kifle
• Bong Sup Kim, M.D.
• David Yul Kim, D.D.S.
• Emily Hyemin Kim
• Hang Sig Kim, M.D.

• Physical Therapist in Shoreline, WA
• Providers in Shoreline, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.