NPIMap

Organization Active NPI

Experience Momentum

  • Physical Therapist
  • Lynnwood, WA
National Provider Identifier
1639414766
Registry record updated Mar 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
602579792 Issued in WA
Legal business name
EXPERIENCE MOMENTUM
Practice address
4030 Alderwood Mall Blvd
Lynnwood, WA 98036
Phone
(425) 776-0803
Fax
(425) 776-0813
NPI assigned
Nov 29, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2023

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

Authorized official

Name
Rhoda Chavez-Nowlan
Title
Billing Manager, Finance
Phone
(425) 776-0803

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 602579792 WA Primary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X 602579792 WA

Addresses

Primary practice location

4030 Alderwood Mall Blvd
Lynnwood, WA 98036

Mailing address

4030 Alderwood Mall Blvd
Lynnwood, WA 98036
Phone (425) 776-0803

National Provider Directory

National Provider Directory
Tax ID family
Experience Momentum Inc - Mill Creek3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1639414766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4030 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98036",
            "telephone_number": "425-776-0803",
            "fax_number": "425-773-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4030 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "98036",
            "telephone_number": "425-776-0803",
            "fax_number": "425-776-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENCE MOMENTUM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ-NOWLAN",
        "authorized_official_first_name": "RHODA",
        "authorized_official_title_or_position": "BILLING MANAGER, FINANCE",
        "authorized_official_telephone_number": "425-776-0803"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "602579792",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "602579792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.