Farris Ashley Rae Waggoner, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT61149357 Issued in WA

Practice address

20818 44TH Ave W Ste 270-P
Lynnwood, WA 98036-7709

Phone

(425) 672-2716

Fax

(425) 672-2720

NPI assigned

Jan 3, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Farris Ashley Rae Former name

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": "1641168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1801557897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 6TH AVE S APT B201",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980204635",
            "telephone_number": "425-749-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20818 44TH AVE W STE 270-P",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980367709",
            "telephone_number": "425-672-2716",
            "fax_number": "425-672-2720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "FARRIS",
        "middle_name": "ASHLEY RAE",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-01-03",
        "certification_date": "2021-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61149357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FARRIS",
            "last_name": "RAE",
            "middle_name": "ASHLEY",
            "credential": "PT, DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 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.