Individual provider Active NPI

Jennifer Ann Lesko, PHYSICAL THERAPIST

  • Physical Therapist
  • Seattle, WA
National Provider Identifier
1366428674
Registry record updated Nov 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00008000 Issued in WA
Practice address
428 1St Ave W
Tai Queen Ann Physical Therapy
Seattle, WA 98119-4018
Phone
(206) 352-0105
Fax
(206) 352-0106
NPI assigned
Dec 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00008000 WA Primary
Physical Therapist 225100000X 3921 OR

Addresses

Primary practice location

428 1St Ave W
Tai Queen Ann Physical Therapy
Seattle, WA 98119-4018

Mailing address

16083 SW Upper Boones Ferry Rd
Ste. 300
Tigard, OR 97224-7736
Phone (800) 219-8835

Other identifiers 2

IdentifierTypeStateIssuer
8370926MedicaidWA
1366428674MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100511000657 WA Practitioner - Physical Therapist in Private Practice 8527950823 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Therapeutic Associates IncGroup PAC ID 0042116279, 319 clinicians

Practice addresses (Care Compare)

4532 42ND Ave SW
Suite 101
Seattle, WA 98116-4759
Phone (206) 932-8363

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3921ORMDPhysical Therapist
PT00008000WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Therapeutic Associates Inc Physical Therapist CurrentSince Mar 6, 2000 Accepting new patients
Therapeutic Associates Inc Physical Therapist Current Accepting new patients
Therapeutic Associates Inc Physical Therapist CurrentSince Mar 6, 2000 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients

Locations

16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153

1408 N Louisiana St
Ste 104A
Kennewick, WA 99336
Phone (509) 783-1962

17901 Bothell Everett Hwy
Mill Creek, WA 98012
Phone (425) 424-3924

4250 Martin Way E
Ste 105
Olympia, WA 98516
Phone (360) 486-0640

5420 Barnes Ave NW
Seattle, WA 98107
Phone (206) 789-7975

428 1st Ave W
Seattle, WA 98119
Phone (206) 352-0105

4532 42nd Ave SW
Ste 101
Seattle, WA 98116
Phone (206) 932-8363

17700 SE Mill Plain Blvd
Ste 150
Vancouver, WA 98683
Phone (360) 514-9383

Interoperability endpoints

  • Direct secure messaging: jennifer.lesko.1@31414.direct.athenahealth.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1366428674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD",
            "address_2": "STE. 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "800-219-8835",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "428 1ST AVE W",
            "address_2": "TAI QUEEN ANN PHYSICAL THERAPY",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981194018",
            "telephone_number": "206-352-0105",
            "fax_number": "206-352-0106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESKO",
        "first_name": "JENNIFER",
        "middle_name": "ANN",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-19",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008000",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "3921",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8370926",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366428674",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.