Provider Demographics
NPI:1992875314
Name:PARE, JESSICA ANN (MPT, OCS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:PARE
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:SHATTUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-313-3051
Mailing Address - Fax:425-625-3517
Practice Address - Street 1:510 8TH AVE NE STE 340
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-5449
Practice Address - Country:US
Practice Address - Phone:425-313-3051
Practice Address - Fax:425-313-3055
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009591225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1024073Medicaid
WA8939554OtherCRIME VICTIMS
WA192071OtherDEPT OF LABOR & INDUSTRY
WA8266SHOtherREGENCE BLUE SHIELD
WA8413916Medicaid
WAP00181248OtherRAILROAD MEDICARE
WA291580OtherDEPT OF LABOR & INDUSTRY
WA8266SHOtherREGENCE BLUE SHIELD