Basic Information
Provider Information | |||||||||
NPI: | 1184991333 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FORD | ||||||||
FirstName: | JONETTE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1050 140TH AVE NE | ||||||||
Address2: | STE D | ||||||||
City: | BELLEVUE | ||||||||
State: | WA | ||||||||
PostalCode: | 980052972 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4256880223 | ||||||||
FaxNumber: | 4256880323 | ||||||||
Practice Location | |||||||||
Address1: | 7728 204TH ST NE UNIT A | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON | ||||||||
State: | WA | ||||||||
PostalCode: | 982232500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3604038250 | ||||||||
FaxNumber: | 3604030917 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/16/2011 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA 60243151 | WA | N |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |   | 225100000X | PT60569 | WA | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
ID Information
ID | Type | State | Issuer | Description | G8952320 | 01 | WA | MEDICARE | OTHER | G8952321 | 01 | WA | MEDICARE | OTHER | 0354547 | 01 | WA | L & I | OTHER | G8952318 | 01 | WA | MEDICARE | OTHER | G8952319 | 01 | WA | MEDICARE | OTHER | G8952322 | 01 | WA | MEDICARE | OTHER | 0355286 | 01 | WA | L & I | OTHER |