Active NPI
Blake Kilvington Stephens, PT
- Physical Therapist
- Lynnwood, WA
National Provider Identifier
1437581840
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT60401636
- Practice address
- 4030 Alderwood Mall Blvd
Lynnwood, WA 98036 - Phone
- (425) 776-0803
- Fax
- (425) 776-0813
- NPI assigned
- Aug 7, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60401636 | WA | Primary |
Addresses
Primary practice location
4030 Alderwood Mall Blvd
Lynnwood, WA 98036
Mailing address
4030 Alderwood Mall Blvd
Lynnwood, WA 98036
Phone (425) 776-0803
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
| License | State | Type | Specialty |
|---|---|---|---|
| PT60401636 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423526400000",
"number": "1437581840",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4030 ALDERWOOD MALL BLVD",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "98036",
"telephone_number": "425-776-0803",
"fax_number": "425-776-0813"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 ALDERWOOD MALL BLVD",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "98036",
"telephone_number": "425-776-0803",
"fax_number": "425-776-0813"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEPHENS",
"first_name": "BLAKE",
"middle_name": "KILVINGTON",
"name_prefix": "Dr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-08-07",
"last_updated": "2015-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60401636",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.