Active NPI
Maren Sederquist, MES, CPT, CSCS
- Rehabilitation Practitioner
- San Jose, CA
National Provider Identifier
1790540896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 1149 Kotenberg Ave
San Jose, CA 95125 - Phone
- (650) 336-0087
- NPI assigned
- Feb 19, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Educator | 174H00000X | |||
| Clinical Exercise Physiologist | 224Y00000X | |||
| Kinesiotherapist | 226300000X | |||
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
1149 Kotenberg Ave
San Jose, CA 95125
Mailing address
PO Box 60538
Palo Alto, CA 94306
Phone (650) 336-0087
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1708300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1708300800000",
"number": "1790540896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 60538",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "94306",
"telephone_number": "650-336-0087"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1149 KOTENBERG AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "95125",
"telephone_number": "650-336-0087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEDERQUIST",
"first_name": "MAREN",
"credential": "MES, CPT, CSCS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-19",
"last_updated": "2024-02-19",
"certification_date": "2024-02-16",
"status": "A"
},
"taxonomies": [
{
"code": "174H00000X",
"taxonomy_group": "",
"desc": "Health Educator",
"state": null,
"license": null,
"primary": false
},
{
"code": "224Y00000X",
"taxonomy_group": "",
"desc": "Clinical Exercise Physiologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "226300000X",
"taxonomy_group": "",
"desc": "Kinesiotherapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.