Individual provider Active NPI

Jordan Bork, DPT

  • Physical Therapist
  • Kirkland, WA
National Provider Identifier
1609356070
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60869454 Issued in WA
Practice address
209 Kirkland Ave
Kirkland, WA 98033-6503
Phone
(425) 629-3502
Fax
(425) 629-3517
NPI assigned
Aug 15, 2018
Last updated
Oct 17, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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 PT60869454 WA Primary

Addresses

Primary practice location

209 Kirkland Ave
Kirkland, WA 98033-6503

Mailing address

209 Kirkland Ave
Kirkland, WA 98033-6503
Phone (425) 629-3502

Other practice location 1

13315 68th Pl NE
Kirkland, WA 98034-1650
Phone (877) 390-6659

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181016003209 WA Practitioner - Physical Therapist in Private Practice 2769734920 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Washington Physical Therapy LLCGroup PAC ID 3476679812, 54 clinicians

Practice addresses (Care Compare)

209 Kirkland Ave
Kirkland, WA 98033-6503
Phone (425) 629-3502

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60869454WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Washington Luna Care Physical Therapy LLC Physical Therapist CurrentSince Nov 1, 2019 Accepting new patients
Lake Washington Physical Therapy LLC Physical Therapist CurrentSince Aug 20, 2018 Accepting new patients

Locations

13555 SE 36th St
Ste 100
Bellevue, WA 98006

209 Kirkland Ave
Kirkland, WA 98033
Phone (425) 629-3502

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

NPI Registry JSON

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571270400000",
    "number": "1609356070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 KIRKLAND AVE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980336503",
            "telephone_number": "425-629-3502",
            "fax_number": "425-629-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 KIRKLAND AVE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980336503",
            "telephone_number": "425-629-3502",
            "fax_number": "425-629-3517"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13315 68th Pl NE",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980341650",
            "country_code": "US",
            "telephone_number": "877-390-6659",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORK",
        "first_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-15",
        "last_updated": "2019-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60869454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.