Individual provider Active NPI

Marianne H Bastin, M.S.,P.T.

  • Physical Therapist
  • Puyallup, WA
National Provider Identifier
1962556795
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00003643 Issued in WA
Practice address
402 15TH Ave SE
#100
Puyallup, WA 98372-3709
Phone
(253) 697-5200
Fax
(253) 697-5145
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00003643 WA Primary

Addresses

Primary practice location

402 15TH Ave SE
#100
Puyallup, WA 98372-3709

Mailing address

402 15TH Ave SE
#100
Puyallup, WA 98372-3709
Phone (253) 697-5200

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)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
PT00003643WAMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962556795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 15TH AVE SE",
            "address_2": "#100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723709",
            "telephone_number": "253-697-5200",
            "fax_number": "253-697-5145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 15TH AVE SE",
            "address_2": "#100",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723709",
            "telephone_number": "253-697-5200",
            "fax_number": "253-697-5145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIN",
        "first_name": "MARIANNE",
        "middle_name": "H",
        "name_prefix": "Ms.",
        "credential": "M.S.,P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.