Mindful Movement Physical Therapy, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00005338 Issued in WA

Legal business name

MINDFUL MOVEMENT PHYSICAL THERAPY, LLC

Practice address

3005 Alderwood Mall Pkwy
Suite 100
Lynnwood, WA 98036-6920

Phone

(206) 979-1413

NPI assigned

Apr 28, 2013

Organization subpart

No

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

Authorized official

Name

Susan Mazzaferro-KnowlesNPI 1881641942

Title

Owner

Phone

(206) 979-1413

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 1

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

• Susan Mazzaferro-Knowles, PT

  • Physical Therapist
  • Lynnwood, WA
  • NPI 1881641942
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1367107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1346684792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1570",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982724570",
            "telephone_number": "360-799-6921",
            "fax_number": "360-799-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3005 ALDERWOOD MALL PKWY",
            "address_2": "SUITE 100",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366920",
            "telephone_number": "206-979-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDFUL MOVEMENT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-28",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "MAZZAFERRO-KNOWLES",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "206-979-1413"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LABOR & INDUSTRIES",
            "identifier": "0313855",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan A Miller, ARNP
• Katelyn Sue Milligan, M.S., CCC-SLP
• Byung Ho Min
• June Min, L AC
• Roberta Mina
• Minh Dau, DDS and Raymond Park, DDS PLLC
• Mipa Corp
• Mira Aqua Massage
• Debra Leigh Miranda, VA00021259
• Ehan Mirza

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.