Amanda Wassenar, DPT

Primary specialty

Pediatric Physical TherapistTaxonomy code 2251P0200X

License

PT60970629 Issued in WA

Practice address

10811 SE Kent Kangley Rd
Kent, WA 98030-7108

Phone

(253) 854-5660

Fax

(253) 854-7025

NPI assigned

Jan 20, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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 and National Provider Directory roles.

• RWW Pediatric Rehab Services LLC

  • Clinic/Center
  • Issaquah, WA
  • NPI 1073001913

  Physical Therapist

  NPD

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

{
    "created_epoch": "1579478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1659901528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10811 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307108",
            "telephone_number": "253-854-5660",
            "fax_number": "253-854-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10811 SE KENT KANGLEY RD",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307108",
            "telephone_number": "253-854-5660",
            "fax_number": "253-854-7025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 4th Ave NW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Issaquah",
            "state": "WA",
            "postal_code": "980279371",
            "country_code": "US",
            "telephone_number": "425-392-7989",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20818 44th Ave W Ste 270",
            "address_purpose": "LOCATION",
            "city": "Lynnwood",
            "state": "WA",
            "postal_code": "980367709",
            "country_code": "US",
            "telephone_number": "425-672-2716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASSENAR",
        "first_name": "AMANDA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-20",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60970629",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "WA",
            "license": "PT60970629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2179389",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "amanda.wassenar@rehabwithoutwalls.com",
            "affiliation": "N",
            "address_1": "1301 4th Ave NW Ste 100",
            "city": "Issaquah",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980279371",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Carmela Marcida Washington Harvey, PH.D.
• Washington Physical Therapy Specialist
• Washington Professional Medical Services PLLC
• Enjoli Washington, MSOT, OTR/L
• Lilith Wasmundt
• Tina A Watkinson, SLP
• Renee L Watling, OT
• Anna Waweru
• Naomi Waweru
• WCHS, Inc.

• Pediatric Physical Therapist in Kent, WA
• Providers in Kent, WA by specialty
• Pediatric Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.