Active NPI
Tyra L Malmborg Okelley, PT
- Physical Therapist
- Everett, WA
National Provider Identifier
1730136334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 5029 Evergreen Way
Everett, WA 98203-2826 - Phone
- (425) 252-1642
- Fax
- (425) 258-1824
- NPI assigned
- May 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
5029 Evergreen Way
Everett, WA 98203-2826
Mailing address
4220 132ND St SE
Suite 101
Mill Creek, WA 98012-8999
Phone (425) 357-9380
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5028MA | Other | WA | REGENCE BLUE SHIELD |
| 8385379 | Medicaid | WA | |
| 0264717 | Other | WA | DEPT OF L&I |
| 8875MA | Other | WA | REGENCE BLUE SHIELD |
| 2358MA | Other | WA | REGENCE BLUE SHIELD |
| 4524MA | Other | WA | REGENCE BLUE SHIELD |
| 5342MA | Other | WA | REGENCE BLUE SHIELD |
| 911745305-98203-C007 | Other | WA | TRICARE |
| 0201977 | Other | WA | DEPT. OF LABOR & INDUSTRY |
| 0562MA | Other | WA | REGENCE |
| 8542MA | Other | WA | REGENCE BLUE SHIELD |
| 8935654 | Other | WA | L&I CRIME VICTIMS |
| 911745305-98275-A004 | Other | WA | TRICARE |
| 5066111 | Other | WA | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417564800000",
"number": "1730136334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4220 132ND ST SE",
"address_2": "SUITE 101",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980128999",
"telephone_number": "425-357-9380",
"fax_number": "425-357-9382"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5029 EVERGREEN WAY",
"city": "EVERETT",
"state": "WA",
"postal_code": "982032826",
"telephone_number": "425-252-1642",
"fax_number": "425-258-1824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALMBORG OKELLEY",
"first_name": "TYRA",
"middle_name": "L",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-28",
"last_updated": "2014-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "5028MA",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8385379",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF L&I",
"identifier": "0264717",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "8875MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "2358MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "4524MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "5342MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "911745305-98203-C007",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF LABOR & INDUSTRY",
"identifier": "0201977",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "0562MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "8542MA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I CRIME VICTIMS",
"identifier": "8935654",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "911745305-98275-A004",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "5066111",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.