NPIMap

Individual provider Active NPI

Brenda J Windom, LMP

  • Mechanotherapist
  • Colville, WA
National Provider Identifier
1053648568
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
MechanotherapistTaxonomy code 172M00000X
License
MA 60114035 Issued in WA
Practice address
427 S Oak St
Suite a
Colville, WA 99114-2750
Phone
(509) 846-6367
Fax
(509) 685-9600
NPI assigned
Nov 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Reflexologist 173C00000X NOT REQUIRED WA
Mechanotherapist 172M00000X MA 60114035 WA Primary

Addresses

Primary practice location

427 S Oak St
Suite a
Colville, WA 99114-2750

Mailing address

427 S Oak St
Suite a
Colville, WA 99114-2750
Phone (509) 846-6367

Other identifiers 1

IdentifierTypeStateIssuer
0257488OtherWAL&I PROVIDER

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
MA 60114035WAMDMechanotherapist
NOT REQUIREDWAMDReflexologist

NPI Registry JSON

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287964800000",
    "number": "1053648568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 S OAK ST",
            "address_2": "SUITE A",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142750",
            "telephone_number": "509-846-6367",
            "fax_number": "509-685-9600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 S OAK ST",
            "address_2": "SUITE A",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142750",
            "telephone_number": "509-846-6367",
            "fax_number": "509-685-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINDOM",
        "first_name": "BRENDA",
        "middle_name": "J",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2010-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "WA",
            "license": "NOT REQUIRED",
            "primary": false
        },
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "WA",
            "license": "MA 60114035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I PROVIDER",
            "identifier": "0257488",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; 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.