Tim Shead, MASSAGE THERAPIST

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61337295 Issued in WA

Practice address

1319 NE 134TH St Ste 103
Vancouver, WA 98685-2718

Phone

(360) 574-3141

NPI assigned

Nov 16, 2022

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cke Longevity LLC

  • Massage Therapist
  • Vancouver, WA
  • NPI 1104263599
  NPD (past)

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

{
    "created_epoch": "1668556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668556800000",
    "number": "1104535343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5602 NE 252ND AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986829191"
        },
        {
            "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": "SHEAD",
        "first_name": "TIM",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-16",
        "last_updated": "2022-11-16",
        "certification_date": "2022-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61337295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William G Shawler, MD
• Shawn P Platt DMD PLLC
• Kathleen A Shay, PHD
• Roger P Shea, MD
• Tobias Shea
• Mark D Sheahan, MS, CAAR, LMHC
• Debra L Shearer, LMD
• Kevin Douglas Shearer, D.C.
• Amna Shebani, D.D.S.
• Sabrina M. Sheehy, LCSW, MSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; 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.