Healthcare Provider Details

I. General information

NPI: 1992875314
Provider Name (Legal Business Name): JESSICA ANN PARE MPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ANN SHATTUCK MPT

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE STE 340
ISSAQUAH WA
98029-5449
US

IV. Provider business mailing address

510 8TH AVE NE STE 320
ISSAQUAH WA
98029-5436
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-3051
  • Fax: 425-313-3055
Mailing address:
  • Phone: 425-313-3051
  • Fax: 425-625-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009591
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT00009591
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT00009591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: