Mountlake Sports & Physical Therapy PS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00003917 Issued in WA

Legal business name

MOUNTLAKE SPORTS & PHYSICAL THERAPY PS

Practice address

9505 19TH Ave SE
101
Everett, WA 98208-3853

Phone

(425) 379-8120

Fax

(425) 338-1789

NPI assigned

Feb 22, 2012

Organization subpart

No

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

Authorized official

Name

Jamie Malijan

Title

Clinical Manager

Phone

(425) 379-8120

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edwin Tria Malijan, R.P.T.

  • Physical Therapist
  • Everett, WA
  • NPI 1588718027
  Medicare reassignment NPD
• Mary H Kunz, LMP

  • Massage Therapist
  • Everett, WA
  • NPI 1245366863
  NPD (past)
• Angelic Schoenfelder, LMP

  • Massage Therapist
  • Everett, WA
  • NPI 1891823274
  NPD (past)
• Karla Geralynn St. Clair, LMP

  • Massage Therapist
  • Everett, WA
  • NPI 1144356999
  NPD (past)

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

{
    "created_epoch": "1329868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329868800000",
    "number": "1528331402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 19TH AVE SE",
            "address_2": "101",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083853",
            "telephone_number": "425-379-8120",
            "fax_number": "425-338-1789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9505 19TH AVE SE",
            "address_2": "101",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083853",
            "telephone_number": "425-379-8120",
            "fax_number": "425-338-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTLAKE SPORTS & PHYSICAL THERAPY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-22",
        "last_updated": "2012-02-22",
        "status": "A",
        "authorized_official_last_name": "MALIJAN",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_title_or_position": "CLINICAL MANAGER",
        "authorized_official_telephone_number": "425-379-8120"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003917",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60178380",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00018299",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00015079",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7084650",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR & INDUSTRIES",
            "identifier": "0151396",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pasha Mostofi, MD, DMD
• Hira Moten
• Janet Lea Mott
• Kay L Moua, ARNP
• Mountainside Counseling LLC
• Loretta Fay Mounts, RPH
• Moving Forward Washington, PLLC
• Mindy Marlene Mowers, LMHC
• Esther Moy, MD
• Marissa Mseitif

• Physical Therapist in Everett, WA
• Providers in Everett, 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 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.