Jeanette Lillian Lundberg, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00000784 Issued in WA

Practice address

300 E College Way
Suite B
Mount Vernon, WA 98273-5429

Phone

(360) 428-6677

Fax

(369) 428-7635

NPI assigned

Oct 21, 2005

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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Blanchard Mountain Physical Therapy PLLC

  • Physical Therapist
  • Mount Vernon, WA
  • NPI 1801642871
  NPD

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233792000000",
    "number": "1891785804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1789",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982731789",
            "telephone_number": "360-428-6677",
            "fax_number": "360-428-7635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E COLLEGE WAY",
            "address_2": "SUITE B",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735429",
            "telephone_number": "360-428-6677",
            "fax_number": "369-428-7635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDBERG",
        "first_name": "JEANETTE",
        "middle_name": "LILLIAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-21",
        "last_updated": "2009-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00000784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7035843",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Yic-Mun Lu, MSW, LSWAIC
• Lori Renae Lubbers, LICSW
• Rosemarie Luces
• Luna Healthcare LLC
• Pene Kristina Lund, COUNSELOR
• Samantha Kerry Lundell
• Leanne Marie Lunsford-Haywood, M.A.,L.M.H.C.
• Lupita Fernandez, DMD, PS
• Bob Allen Ly, D.O.
• Kelly Ann Lynch Ring, LMP, RF

• Physical Therapist in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2009; 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.