Active NPI
Mitchell Tyree Plummer II, LMT
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1053870790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 1319 NE 134TH St Ste 103
Vancouver, WA 98685-2718 - Phone
- (360) 574-3141
- NPI assigned
- Mar 12, 2019
- Last updated
- Mar 12, 2019
- Sex
- Male
- Sole proprietor
- No
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 | NU | Primary |
Addresses
Primary practice location
1319 NE 134TH St Ste 103
Vancouver, WA 98685-2718
Mailing address
9308 NE 99TH St
Vancouver, WA 98662-1963
Phone (093) 103-4365
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cke Longevity LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1053870790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9308 NE 99TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986621963",
"telephone_number": "093-103-4365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1319 NE 134TH ST STE 103",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986852718",
"telephone_number": "360-574-3141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PLUMMER",
"first_name": "MITCHELL",
"middle_name": "TYREE",
"name_prefix": "Mr.",
"name_suffix": "II",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-03-12",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.