Active NPI
Jillene M Lund, PT
- Physical Therapist
- Graham, WA
National Provider Identifier
1962495820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00008461
- Practice address
- 21806 103Rd Avenue CT E
#202
Graham, WA 98338-8115 - Phone
- (253) 847-3700
- Fax
- (253) 847-9622
- NPI assigned
- Aug 25, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00008461 | WA | Primary |
Addresses
Primary practice location
21806 103Rd Avenue CT E
#202
Graham, WA 98338-8115
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8938975 | Other | WA | CRIME VICTIMS |
| 2043LU | Other | WA | REGENCE B/S |
| 8333866 | Medicaid | WA | |
| A024 | Other | WA | TRICARE |
| 181190 | Other | WA | DEPT OF L&I |
| 0290926 | Other | WA | DEPT. OF LABOR AND INDUSTRIES |
Other names 1
- Jillene M Bacon
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436745600000",
"number": "1962495820",
"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",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21806 103RD AVENUE CT E",
"address_2": "#202",
"city": "GRAHAM",
"state": "WA",
"postal_code": "983388115",
"telephone_number": "253-847-3700",
"fax_number": "253-847-9622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUND",
"first_name": "JILLENE",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-25",
"last_updated": "2015-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00008461",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8938975",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE B/S",
"identifier": "2043LU",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8333866",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "A024",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF L&I",
"identifier": "181190",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF LABOR AND INDUSTRIES",
"identifier": "0290926",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JILLENE",
"last_name": "BACON",
"middle_name": "M",
"credential": "PT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Graham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.