Active NPI
Tera Tagliabue, DPT
- Physical Therapist
- Bothell, WA
National Provider Identifier
1902155609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 60280480
- Practice address
- 18404 102ND Ave NE
Suite a
Bothell, WA 98011-3380 - Phone
- (425) 486-6079
- NPI assigned
- Sep 10, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 60280480 | WA | Primary |
| Massage Therapist | 225700000X | MA 00019510 | WA |
Addresses
Primary practice location
18404 102ND Ave NE
Suite a
Bothell, WA 98011-3380
Mailing address
18404 102ND Ave NE
Suite a
Bothell, WA 98011-3380
Phone (425) 486-6079
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 60280480 | WA | MD | Physical Therapist |
| MA 00019510 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347235200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347235200000",
"number": "1902155609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18404 102ND AVE NE",
"address_2": "SUITE A",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980113380",
"telephone_number": "425-486-6079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18404 102ND AVE NE",
"address_2": "SUITE A",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980113380",
"telephone_number": "425-486-6079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAGLIABUE",
"first_name": "TERA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-10",
"last_updated": "2012-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 60280480",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA 00019510",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.