Active NPI
Aleksey Bogdanov, LMT
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1073055687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60609990
- Practice address
- 3021 NE 72ND Dr
#15
Vancouver, WA 98661-7300 - Phone
- (360) 260-6903
- Fax
- (360) 260-4849
- NPI assigned
- Nov 14, 2016
- 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 | MA60609990 | WA | Primary |
Addresses
Primary practice location
3021 NE 72ND Dr
#15
Vancouver, WA 98661-7300
Mailing address
305 Council Bluffs Way
Vancouver, WA 98661-7509
Phone (360) 773-2602
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA60609990 | Other | WA | STATE MASSAGE LICENSE |
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 |
|---|---|---|---|
| MA60609990 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1073055687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 COUNCIL BLUFFS WAY",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986617509",
"telephone_number": "360-773-2602",
"fax_number": "360-260-4849"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3021 NE 72ND DR",
"address_2": "#15",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986617300",
"telephone_number": "360-260-6903",
"fax_number": "360-260-4849"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGDANOV",
"first_name": "ALEKSEY",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-11-14",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60609990",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE MASSAGE LICENSE",
"identifier": "MA60609990",
"state": "WA"
}
],
"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 Nov 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.