Shin Wook Park, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160925668 Issued in WA

Practice address

15315 1St Ave NE
Duvall, WA 98019-5004

Phone

(425) 788-0505

NPI assigned

May 12, 2020

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Serenity Medical Massage & Bodywork LLC

  • Specialist
  • Duvall, WA
  • NPI 1215470281
  NPD (past)

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1679195754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10014 NE 127TH PL APT A205",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980348804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15315 1ST AVE NE",
            "city": "DUVALL",
            "state": "WA",
            "postal_code": "980195004",
            "telephone_number": "425-788-0505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SHIN WOOK",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-12",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160925668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael J Noblin, M.A., LMHCA
• Wendy Jo Nygaard, ATC, CSCS
• Kelly Oberbillig
• Kaitlin Colleen Obrien Oliver, LMHCA,ESA
• Antonio Ignacio Palacios, E.A.M.P.
• Talia Parker, LMHCA
• Passages Perinatal Counseling, PLLC
• Alyssa Perez
• Julia Elizabeth Perry, MA LMHC CDP
• Pooja W Bhardwaj DDS PLLC

• Physical Therapy Assistant in Duvall, WA
• Providers in Duvall, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.

Verify at the official NPI Registry.