Active NPI
Glenn F Tate, LMP
- Massage Therapist
- Kenmore, WA
National Provider Identifier
1033413083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60172753
- Practice address
- 17620 80TH Ave NE
Apt# 302
Kenmore, WA 98028-6602 - Phone
- (425) 949-2617
- NPI assigned
- Jan 5, 2011
- Last updated
- Jan 5, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA60172753 | WA | Primary |
Addresses
Primary practice location
17620 80TH Ave NE
Apt# 302
Kenmore, WA 98028-6602
Mailing address
17620 80TH Ave NE
Apt# 302
Kenmore, WA 98028-6602
Phone (425) 949-2617
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
| License | State | Type | Specialty |
|---|---|---|---|
| MA60172753 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1294185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294185600000",
"number": "1033413083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17620 80TH AVE NE",
"address_2": "APT# 302",
"city": "KENMORE",
"state": "WA",
"postal_code": "980286602",
"telephone_number": "425-949-2617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17620 80TH AVE NE",
"address_2": "APT# 302",
"city": "KENMORE",
"state": "WA",
"postal_code": "980286602",
"telephone_number": "425-949-2617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TATE",
"first_name": "GLENN",
"middle_name": "F",
"name_prefix": "Mr.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-01-05",
"last_updated": "2011-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60172753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenmore, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.