Individual provider Active NPI

Krystle Winkyaw, LMT

  • Massage Therapist
  • Woodinville, WA
National Provider Identifier
1023614583
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA61106340 Issued in WA
Practice address
17618 140TH Ave NE
Woodinville, WA 98072-6800
Phone
(425) 402-9772
NPI assigned
Dec 9, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA61106340 WA Primary

Addresses

Primary practice location

17618 140TH Ave NE
Woodinville, WA 98072-6800

Mailing address

17618 140TH Ave NE
Woodinville, WA 98072-6800
Phone (425) 402-9772

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

State licenses

LicenseStateTypeSpecialty
MA61106340WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Physical Rehabilitation LLC CurrentSince Dec 13, 2020 Accepting new patients
Elevate Physical Rehabilitation Group PLLC CurrentSince Dec 13, 2020 Accepting new patients

Locations

17618 140th Ave NE
Woodinville, WA 98072
Phone (425) 402-9772

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607472000000",
    "number": "1023614583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17618 140TH AVE NE",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980726800",
            "telephone_number": "425-402-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17618 140TH AVE NE",
            "city": "WOODINVILLE",
            "state": "WA",
            "postal_code": "980726800",
            "telephone_number": "425-402-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINKYAW",
        "first_name": "KRYSTLE",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61106340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodinville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.