Stephanie Ann Boutry, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60045917 Issued in WA

Practice address

5704 E Lake Sammamish Pkwy SE
Ste. #101
Issaquah, WA 98029

Phone

(425) 270-3323

Fax

(425) 270-3326

NPI assigned

Sep 30, 2008

Last updated

Jan 8, 2015By the provider in NPPES

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

• Stephanie Ann Cearns Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1420675200000",
    "number": "1922259688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5704 E LAKE SAMMAMISH PKWY SE",
            "address_2": "STE. #101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98029",
            "telephone_number": "425-270-3323",
            "fax_number": "425-270-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5704 E LAKE SAMMAMISH PKWY SE",
            "address_2": "STE. #101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "98029",
            "telephone_number": "425-270-3323",
            "fax_number": "425-270-3326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUTRY",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-30",
        "last_updated": "2015-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60045917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "CEARNS",
            "middle_name": "ANN",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Joseph Cheng Borin, DPT, MOTR/L
• Brenna Born, M.D.
• Anita Lynn Boser, LMP, CHP
• Mark Daniel Bouchard, MD
• Bouchy, LLC (The Gardens At Issaquah)
• Kelli Bowden
• Stephanie Anne Bowser, PSYD
• Luke Boyer, D.C.
• Thomas Boyer, DO
• Robert J Bradbury, PT

• Physical Therapist in Issaquah, WA
• Providers in Issaquah, 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 8, 2015; 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.