Individual provider Active NPI

Tesse Lane Maciejko, DPT

  • Physical Therapist
  • Winthrop, WA
National Provider Identifier
1366092272
Registry record updated Sep 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL.0016628 Issued in CO
Practice address
202 White Ave
Winthrop, WA 98862-9774
Phone
(509) 996-8234
Fax
(509) 996-2193
NPI assigned
Sep 13, 2019
Last updated
Sep 25, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2026

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT7383 ME
Physical Therapist 225100000X PTL.0016628 CO Primary
Physical Therapist 225100000X 196622 AK
Physical Therapist 225100000X PT.PT.70135962 WA
Physical Therapist 225100000X 21536 MT
Physical Therapist 225100000X 318 VI

Addresses

Primary practice location

202 White Ave
Winthrop, WA 98862-9774

Mailing address

202 White Ave
Winthrop, WA 98862-9774
Phone (509) 996-8234

Other practice location 1

230 Dalton Street
Haines, AK 99827
Phone (907) 766-6390 ext. 66027

Other practice location 2

710 11th St N
Columbus, MT 59019-7215
Phone (406) 322-1000

Other practice location 3

2525 N Broadway Ave
Red Lodge, MT 59068-9222
Phone (406) 446-2345

Other practice location 4

611 E Star Ct
Suite B
Montrose, CO 81401-6704
Phone (970) 249-1646 ext. 2863

Other practice location 5

9053 Estate Thomas Suite 206
St. Thomas, VI 00802
Phone (340) 779-9355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, VI, ME3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20191021000725 CO Practitioner - Physical Therapist in Private Practice 7911238191
I20251222002811 VI Practitioner - Physical Therapist in Private Practice 7911238191 Reassigns benefits to 1 organization
I20260427000180 ME Practitioner - Physical Therapist in Private Practice 7911238191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cog Restore, LLCGroup PAC ID 1557665502, 10 clinicians

Practice addresses (Care Compare)

45 Wells PLZ
Suite 10
Wells, ME 04090-4146
Phone (207) 641-2292

9053 Estate Thomas
Royal Palms Suite 206
St Thomas, VI 00802
Phone (340) 779-9355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21536MTMDPharmacist
196622AKMDPhysical Therapist
PTL.0016628COMDPhysical Therapist
PT7383MEMDPhysical Therapist
318VIMDPhysical Therapist
PT.PT.70135962WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cog Restore, LLC Physical Therapist CurrentSince Dec 1, 2025 Accepting new patients
In Motion Hand Therapy Inc Physical Therapist CurrentSince Sep 16, 2019 Accepting new patients
Montrose Memorial Hospital, Inc PastSince Sep 15, 2019 Accepting new patients

Locations

611 East Star Ct
Ste B
Montrose, CO 81401
Phone (970) 249-1646

4006 Estate Diamond
Ste 103
St Croix, VI 00820
Phone (340) 779-9355

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1568332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1366092272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 WHITE AVE",
            "city": "WINTHROP",
            "state": "WA",
            "postal_code": "988629774",
            "telephone_number": "509-996-8234",
            "fax_number": "509-996-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 WHITE AVE",
            "city": "WINTHROP",
            "state": "WA",
            "postal_code": "988629774",
            "telephone_number": "509-996-8234",
            "fax_number": "509-996-2193"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Dalton Street",
            "address_purpose": "LOCATION",
            "city": "Haines",
            "state": "AK",
            "postal_code": "99827",
            "country_code": "US",
            "telephone_number": "907-766-6390 x66027",
            "fax_number": "907-766-6305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "710 11th St N",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "MT",
            "postal_code": "590197215",
            "country_code": "US",
            "telephone_number": "406-322-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2525 N Broadway Ave",
            "address_purpose": "LOCATION",
            "city": "Red Lodge",
            "state": "MT",
            "postal_code": "590689222",
            "country_code": "US",
            "telephone_number": "406-446-2345",
            "fax_number": "406-446-0095",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "611 E Star Ct",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Montrose",
            "state": "CO",
            "postal_code": "814016704",
            "country_code": "US",
            "telephone_number": "970-249-1646 x2863",
            "fax_number": "970-249-8899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9053 Estate Thomas Suite 206",
            "address_purpose": "LOCATION",
            "city": "St. Thomas",
            "state": "VI",
            "postal_code": "00802",
            "country_code": "US",
            "telephone_number": "340-779-9355",
            "fax_number": "340-779-9350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACIEJKO",
        "first_name": "TESSE",
        "middle_name": "LANE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-13",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT7383",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL.0016628",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "196622",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT.PT.70135962",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "21536",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VI",
            "license": "318",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winthrop, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2026; 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.