Individual provider Active NPI

Evan Thomas Martina, DPT

  • Physical Therapist
  • Mill Creek, WA
National Provider Identifier
1578792115
Registry record updated Jan 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60094476 Issued in WA
Practice address
16030 Bothell Everett Hwy Ste 200
Mill Creek, WA 98012-1273
Phone
(425) 745-4910
Fax
(425) 338-5709
NPI assigned
Jul 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2022

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 PT60094476 WA Primary

Addresses

Primary practice location

16030 Bothell Everett Hwy Ste 200
Mill Creek, WA 98012-1273

Mailing address

16030 Bothell Everett Hwy Ste 200
Mill Creek, WA 98012-1273
Phone (425) 745-4910

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110208000761 WA Practitioner - Physical Therapist in Private Practice 5496935470 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redmond Physical Therapy IncGroup PAC ID 5496943516, 18 clinicians

Practice addresses (Care Compare)

16030 Bothell Everett Hwy
Suite 200
Mill Creek, WA 98012-1273
Phone (425) 745-4910

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60094476WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Redmond Physical Therapy, Inc. Physical Therapist CurrentSince Sep 16, 2019 Accepting new patients

Locations

12911 120th Ave NE
Ste F120
Kirkland, WA 98034
Phone (425) 305-2940

16030 Bothell Hwy
Ste 200
Mill Creek, WA 98012
Phone (425) 745-4910

16261 Redmond Way
#100
Redmond, WA 98052
Phone (425) 881-3001

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": "1246492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1578792115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 200",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-745-4910",
            "fax_number": "425-338-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 BOTHELL EVERETT HWY STE 200",
            "city": "MILL CREEK",
            "state": "WA",
            "postal_code": "980121273",
            "telephone_number": "425-745-4910",
            "fax_number": "425-338-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINA",
        "first_name": "EVAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-02",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60094476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Creek, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.