Michael A Pennington, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00008861 Issued in WA

Practice address

701 M St NE
Suite 102
Auburn, WA 98002-4591

Phone

(253) 833-8766

Fax

(252) 833-6748

NPI assigned

Aug 25, 2005

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

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Outpatient Physical Therapy and Sports Rehabilitation Inc PCGroup PAC ID 3678487063, 30 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Outpatient Physical Therapy & Sports Rehabilitation Inc PC

  • Physical Therapist
  • Maple Valley, WA
  • NPI 1730394420
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1124928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1730172602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26837 MAPLE VALLEY BLACK DIAMOND RD SE",
            "address_2": "SUITE 200",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980389917",
            "telephone_number": "425-413-4427",
            "fax_number": "425-413-4402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 M ST NE",
            "address_2": "SUITE 102",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980024591",
            "telephone_number": "253-833-8766",
            "fax_number": "252-833-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENNINGTON",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-25",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8334153",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "161592",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "5453PE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "R/R MED",
            "identifier": "650024235",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8937391",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lorna Pella, LICSW, ACSW
• Areianna Pellum
• Diana L Pena Prudente Ventura, CPT
• Samala J Penalver, NP
• Viviana Andrea Penaranda, RD, CD
• James P Pepka, D. O.
• Shannon Elisabeth Percival, PA-C
• Berenice Perez Flores
• Anita Shante Perez
• Brianna Perez

• Physical Therapist in Auburn, WA
• Providers in Auburn, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.