Lake Sammamish Physical Therapy, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

LAKE SAMMAMISH PHYSICAL THERAPY, PLLC

Practice address

6520 226TH PL SE Ste 201
Issaquah, WA 98027-8969

Phone

(425) 391-5504

Fax

(425) 391-3670

NPI assigned

Apr 19, 2007

Last updated

Nov 27, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dwan Diaz

Title

Credentialing Coordinator

Phone

(425) 450-9474

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Lake Sammamish Physical Therapy Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• William R Pfister Jr., PT

  • Physical Therapist
  • Puyallup, WA
  • NPI 1780619239
  NPD

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606435200000",
    "number": "1740407816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 NE 12TH ST STE 3A",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980052461",
            "telephone_number": "425-450-9474",
            "fax_number": "425-452-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6520 226TH PL SE STE 201",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980278969",
            "telephone_number": "425-391-5504",
            "fax_number": "425-391-3670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE SAMMAMISH PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2020-11-27",
        "certification_date": "2020-11-27",
        "status": "A",
        "authorized_official_last_name": "DIAZ",
        "authorized_official_first_name": "DWAN",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "425-450-9474"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0039830",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Sammamish Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christina Sukjin Kwon
• Yong Kwon, O.D
• Marilyn Ann Lacelle, MSW
• Kara Lackowski, MSOT
• Lake Sammamish Family Dentistry
• Nathan O Lake, RN
• Lakeside Family Physicians PLLC
• Natalie Lam, O.D.
• Jeffrey Landesberg, MD
• Patrick Duncan Landreth

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.