Edwin Tria Malijan, R.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00003917 Issued in WA

Practice address

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

Phone

(425) 379-8120

Fax

(425) 338-1789

NPI assigned

Jan 22, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Washington School of Medicine, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mountlake Sports & Physical Therapy PS

  • Physical Therapist
  • Everett, WA
  • NPI 1528331402
  Medicare reassignment NPD

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1588718027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 19TH AVE SE",
            "address_2": "SUITE 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": "SUITE 101",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982083853",
            "telephone_number": "425-379-8120",
            "fax_number": "425-338-1789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALIJAN",
        "first_name": "EDWIN",
        "middle_name": "TRIA",
        "credential": "R.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO, QPOS ID#",
            "identifier": "2243189",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7084650",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA&CAQH PROVIDER ID#",
            "identifier": "11362400",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I PROVIDER ID#",
            "identifier": "0115893",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO,POS,EPO ID#",
            "identifier": "7076062",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lizbeth Maldonado Angeles
• Andrea Lorraine Maldonado, MA, CLIN 2
• Ashley Maldonado
• Caitlynn Elizabeth Maldonado, MA
• Glory Malenga
• Amy Malinowski, DPT
• Dane Mallahan
• Melissa Mallory
• Tina Malm, PA
• Tyra L Malmborg Okelley, PT

• 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 Jul 9, 2007; 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.