Active NPI
Aaron Ryan Shackelford, LMP
- Massage Therapist
- Mill Creek, WA
National Provider Identifier
1043660731
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60658908
- Practice address
- 1128 164TH St SE
Apt M303
Mill Creek, WA 98012-1716 - Phone
- (574) 540-3935
- NPI assigned
- Jun 14, 2016
- 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 | MA60658908 | WA | Primary |
Addresses
Primary practice location
1128 164TH St SE
Apt M303
Mill Creek, WA 98012-1716
Mailing address
1128 164TH St SE
Apt M303
Mill Creek, WA 98012
Phone (574) 540-3935
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 |
|---|---|---|---|
| MA60658908 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465862400000",
"number": "1043660731",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1128 164TH ST SE",
"address_2": "APT M303",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "98012",
"telephone_number": "574-540-3935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1128 164TH ST SE",
"address_2": "APT M303",
"city": "MILL CREEK",
"state": "WA",
"postal_code": "980121716",
"telephone_number": "574-540-3935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHACKELFORD",
"first_name": "AARON",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-14",
"last_updated": "2016-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60658908",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mill Creek, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 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.