Individual provider Active NPI

Cara Suzanne Federspiel, PHYSICAL THERAPIST

  • Pediatric Physical Therapist
  • Everett, WA
National Provider Identifier
1376897371
Registry record updated Dec 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
License
PT00006699 Issued in WA
Practice address
906 SE Everett Mall Way Ste 200
Everett, WA 98208-3743
Phone
(425) 353-5656
Fax
(425) 513-2807
NPI assigned
Oct 30, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X PT00006699 WA Primary

Addresses

Primary practice location

906 SE Everett Mall Way Ste 200
Everett, WA 98208-3743

Mailing address

906 SE Everett Mall Way Ste 200
Everett, WA 98208-3743
Phone (425) 353-5656

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PT00006699WAMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Childstrive CurrentSince Dec 29, 2019 Accepting new patients

Locations

906 SE Everett Mall Way
Ste 200
Everett, WA 98208
Phone (425) 353-5656

14 E Casino Rd
Ste C
Everett, WA 98208
Phone (425) 513-1663

Organizations & group practices 1

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": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577059200000",
    "number": "1376897371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 SE EVERETT MALL WAY STE 200",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083743",
            "telephone_number": "425-353-5656",
            "fax_number": "425-513-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 SE EVERETT MALL WAY STE 200",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083743",
            "telephone_number": "425-353-5656",
            "fax_number": "425-513-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDERSPIEL",
        "first_name": "CARA",
        "middle_name": "SUZANNE",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-30",
        "last_updated": "2019-12-23",
        "certification_date": "2019-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "WA",
            "license": "PT00006699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.