Individual provider Active NPI

Marielle Elise Bertram, DPT

  • Physical Therapist
  • Kirkland, WA
National Provider Identifier
1922546902
Registry record updated Apr 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
11620 97TH LN NE
Kirkland, WA 98034-4269
Phone
(425) 455-2630
Fax
(425) 451-4390
NPI assigned
Feb 9, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 28367 MD
Physical Therapist 225100000X 2305210875 VA
Physical Therapist 225100000X WA Primary

Addresses

Primary practice location

11620 97TH LN NE
Kirkland, WA 98034-4269

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

2618 N Salisbury Blvd Ste 130
Salisbury, MD 21801-2217
Phone (410) 324-7409

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
86.09 of 100Reported as group
Quality
89.13
Improvement activities
40
Cost
73.57

Merit-based Incentive Payment System (MIPS)

Final score
86.33 of 100Reported as group
Quality
88.06
Improvement activities
40
Cost
76.31

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2305210875VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Effingham Rehab Services, LLC Physical Therapist Current Accepting new patients
Ati Holdings of Arizona, LLC Physical Therapist CurrentSince Apr 28, 2024 Accepting new patients
Effingham Rehab Services, Inc CurrentSince Apr 19, 2023 Accepting new patients
Effingham Rehab Services, LLC CurrentSince Apr 19, 2023 Accepting new patients
Ideal Rehabilitation LLC PastSince Apr 28, 2024 Accepting new patients

Locations

1485 E Florence Blvd
Ste 105
Casa Grande, AZ 85122
Phone (520) 494-3058

11209 N Tatum Blvd
Ste B120
Phoenix, AZ 85028
Phone (602) 595-0204

5110 S Rural Rd
Ste 104
Tempe, AZ 85282
Phone (480) 629-5549

1020 S Harrison Rd
Unit 120
Tucson, AZ 85748
Phone (520) 207-6288

123 Village At Glynn Pl
Brunswick, GA 31525
Phone (912) 208-5170

172 Tower Rd
Jesup, GA 31545
Phone (912) 427-4290

123 Canal St
Ste 203
Pooler, GA 31322
Phone (912) 388-1283

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1486598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712707200000",
    "number": "1922546902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11620 97TH LN NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344269",
            "telephone_number": "425-455-2630",
            "fax_number": "425-451-4390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2618 N Salisbury Blvd Ste 130",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218012217",
            "country_code": "US",
            "telephone_number": "410-324-7409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BERTRAM",
        "first_name": "MARIELLE",
        "middle_name": "ELISE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-09",
        "last_updated": "2024-04-10",
        "certification_date": "2021-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28367",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305210875",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.