Scott Alexander Packebush

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A161315490 Issued in WA

Practice address

13425 SE 30TH St Ste 2C
Bellevue, WA 98005-4450

Phone

(425) 252-3908

NPI assigned

Dec 26, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1640476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1700546264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22500 SE 56TH ST APT 18-301",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295266",
            "telephone_number": "661-331-4473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13425 SE 30TH ST STE 2C",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980054450",
            "telephone_number": "425-252-3908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKEBUSH",
        "first_name": "SCOTT",
        "middle_name": "ALEXANDER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-26",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WA",
            "license": "A161315490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pacific Therapy Group, PLLC
• Pacific Vision Services, PLLC
• Pacifica Behavioral Health
• Wendy Pacifici, LCSW
• Albert Dominick Pacifico II, M.D.
• Llewellyn Nayagam Packia Raj, MD
• Nancy J Padden
• Patricia L Paddison, M.D.
• David P Padilla, PHARMD
• Reynor Ibrahim Padilla

• Athletic Trainer in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Athletic Trainer in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.