Active NPI
Jennifer Kathleen Feagles, DPT
- Physical Therapist
- Lakewood, WA
National Provider Identifier
1588854640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00010517
- Practice address
- 7308 Bridgeport Way W
Suite 103
Lakewood, WA 98499-8000 - Phone
- (253) 582-8142
- Fax
- (253) 582-8160
- NPI assigned
- Jul 25, 2007
- Sex
- Female
- 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 | PT00010517 | WA | Primary |
Addresses
Primary practice location
7308 Bridgeport Way W
Suite 103
Lakewood, WA 98499-8000
Mailing address
406 S 4TH St
Basin, WY 82401-9500
Phone (307) 568-9399
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8490898 | Medicaid | WA |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00010517 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| William H and Carrie Gottsche Foundation | Current | Accepting new patients | |
| Holistic Pain Management of Wyoming, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Gottsche Rehabilitation Center
- Comprehensive Outpatient Rehabilitation Facility (CORF)
- Thermopolis, WY
- NPI 1558319392
-
- Family Nurse Practitioner
- Riverton, WY
- NPI 1487295846
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1580342400000",
"number": "1588854640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 S 4TH ST",
"city": "BASIN",
"state": "WY",
"postal_code": "824019500",
"telephone_number": "307-568-9399",
"fax_number": "307-864-2857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7308 BRIDGEPORT WAY W",
"address_2": "SUITE 103",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984998000",
"telephone_number": "253-582-8142",
"fax_number": "253-582-8160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FEAGLES",
"first_name": "JENNIFER",
"middle_name": "KATHLEEN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-25",
"last_updated": "2020-01-30",
"certification_date": "2020-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00010517",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8490898",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.