Jennifer Anna Phan Prewitt, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60612231 Issued in WA

Practice address

16030 Bothell Everett Hwy Ste 200
Mill Creek, WA 98012-1273

Phone

(425) 745-4910

Fax

(425) 338-5709

NPI assigned

Jul 20, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Jennifer Anna Phan Former name

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Redmond Physical Therapy IncGroup PAC ID 5496943516, 18 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.

• Redmond Physical Therapy, Inc.

  • Physical Therapist
  • Kirkland, WA
  • NPI 1962643965
  Medicare reassignment Care Compare group NPD
• Apple Physical Therapy, LLC

  • Physical Therapist
  • Auburn, WA
  • NPI 1902808470
  Medicare reassignment NPD
• Physical Therapy Dynamix, PLLC

  • Physical Therapy Clinic/Center
  • Seattle, WA
  • NPI 1124511589

  Physical Therapist

  Medicare reassignment NPD
• Apple Physical Therapy LLC

  • Durable Medical Equipment & Medical Supplies
  • Mountlake Terrace, WA
  • NPI 1366746232

  Physical Therapist

  NPD

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

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1336494723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 200",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-745-4910",
            "fax_number": "425-338-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 200",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-745-4910",
            "fax_number": "425-338-5709"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11435 80th Pl S",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981783649",
            "country_code": "US",
            "telephone_number": "425-243-3149",
            "fax_number": "425-207-4980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PREWITT",
        "first_name": "JENNIFER",
        "middle_name": "ANNA PHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CA",
            "license": "PT39197",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60612231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PHAN",
            "middle_name": "ANNA",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Mill Creek, WA
• Providers in Mill Creek, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; 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.