Alejandro Ray Southard-Resa

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60620179 Issued in WA

Practice address

2902 164TH St SW Suite D1
Lynnwood, WA 98087-8801

Phone

(425) 745-2500

NPI assigned

Feb 17, 2016

Last updated

Feb 17, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1455667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1033578216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 191ST PL SE",
            "city": "BOTHELL",
            "state": "WA",
            "postal_code": "980129719",
            "telephone_number": "206-327-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2902 164TH ST SW SUITE D1",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980878801",
            "telephone_number": "425-745-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARD-RESA",
        "first_name": "ALEJANDRO",
        "middle_name": "RAY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-17",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60620179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2016; 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.