Mara Jacobo Amezquita, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61473275 Issued in WA

Practice address

909 S 336TH St Ste 100
Federal Way, WA 98003-7394

Phone

(253) 661-5166

NPI assigned

Jun 26, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

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.

• Starboard Healthcare LLC

  dba Signature Healthcare at Home

  • Multi-Specialty Clinic/Center
  • Federal Way, WA
  • NPI 1770453912
  Medicare reassignment NPD

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1396580981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 S 336TH ST STE 100",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980037394",
            "telephone_number": "253-661-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "909 S 336TH ST STE 100",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980037394",
            "telephone_number": "253-661-5166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBO AMEZQUITA",
        "first_name": "MARA",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61473275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas E. Jacka, D.D.S.
• Nina Jackson-King
• Kyrsten Savannah Jackson-Kinney
• Duane L Jackson Jr., O.D.
• Lisa Marie Jackson
• Ruth Jacobs
• Yonaton A Jacobs, ARNP
• Lilly Rae Jacobsen
• Bret H Jacobson, DDS
• Carl Jacobson, DDS

• Physical Therapist in Federal Way, WA
• Providers in Federal Way, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.