Individual provider Active NPI

Lauren Johnson

  • Physical Therapist
  • Lake Stevens, WA
National Provider Identifier
1538577010
Registry record updated Jul 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60477739 Issued in WA
Practice address
1109 Frontier Cir E
Suite B
Lake Stevens, WA 98258-3442
Phone
(425) 377-1290
NPI assigned
Jul 28, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60477739 WA Primary

Addresses

Primary practice location

1109 Frontier Cir E
Suite B
Lake Stevens, WA 98258-3442

Mailing address

11711 NE 12TH St
Suite 3a
Bellevue, WA 98005-2461
Phone (425) 450-9474

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141024002021 WA Practitioner - Physical Therapist in Private Practice 4688895121 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services- WashingtonGroup PAC ID 8325100480, 527 clinicians

Practice addresses (Care Compare)

4112 Harbour Pointe Blvd SW
Suite 100
Mukilteo, WA 98275-5457
Phone (425) 347-6330

4730 Colby Ave
Suite 220
Everett, WA 98203-2927
Phone (425) 297-6888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60477739WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Therapy Associates, LLC Physical Therapist CurrentSince Dec 13, 2022 Accepting new patients
Providence Health & Services - Wa CurrentSince Aug 14, 2023 Accepting new patients
Providence Health & Services- Washington Physical Therapist CurrentSince Aug 14, 2023 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

21827 76th Ave W
Ste 101
Edmonds, WA 98026
Phone (425) 582-0930

4730 Colby Ave
Ste 220
Everett, WA 98203
Phone (206) 667-3000

4112 Harbour Pointe Blvd SW
Ste 100
Mukilteo, WA 98275
Phone (425) 347-6330

Organizations & group practices 4

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": "1406505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406505600000",
    "number": "1538577010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 NE 12TH ST",
            "address_2": "SUITE 3A",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052461",
            "telephone_number": "425-450-9474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 FRONTIER CIR E",
            "address_2": "SUITE B",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982583442",
            "telephone_number": "425-377-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LAUREN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-28",
        "last_updated": "2014-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60477739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Stevens, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2014; 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.