NPIMap

Organization Active NPI

Jenna Lisenby, DPT, LLC

  • Pediatric Physical Therapist
  • Mount Vernon, WA
National Provider Identifier
1891096194
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Physical TherapistTaxonomy code 2251P0200X
Legal business name
JENNA LISENBY, DPT, LLC
Practice address
1100 Roosevelt Ave Ste D
Mount Vernon, WA 98273-2427
Phone
(360) 336-3432
Fax
(360) 336-3492
NPI assigned
Nov 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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

Authorized official

Name
Mrs. Jenna Anne Lisenby, DPTNPI 1932332566
Title
Owner/ PT
Phone
(360) 336-3432

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00007768 WA
Pediatric Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251P0200X Primary

Addresses

Primary practice location

1100 Roosevelt Ave Ste D
Mount Vernon, WA 98273-2427

Mailing address

1100 Roosevelt Ave Ste D
Mount Vernon, WA 98273-2427
Phone (360) 336-3432

Other names 1

  • Valley Kids Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL play@valleykidstherapy.com Direct

National Provider Directory

National Provider Directory

Locations

400 W Rio Vista Ave
Burlington, WA 98233

1100 Roosevelt Ave
Ste D
Mount Vernon, WA 98273
Phone (360) 336-3432

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607904000000",
    "number": "1891096194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 ROOSEVELT AVE STE D",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732427",
            "telephone_number": "360-336-3432",
            "fax_number": "360-336-3492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 ROOSEVELT AVE STE D",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982732427",
            "telephone_number": "360-336-3432",
            "fax_number": "360-336-3492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNA LISENBY, DPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "LISENBY",
        "authorized_official_first_name": "JENNA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER/ PT",
        "authorized_official_telephone_number": "360-336-3432",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007768",
            "primary": false
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "play@valleykidstherapy.com",
            "affiliation": "N",
            "endpointDescription": "secure email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1100 Roosevelt Ave Ste D",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982732427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Valley Kids Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.