Pandora Justina Liess

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

61104204 Issued in WA

Practice address

4791 W Van Giesen St
West Richland, WA 99353-5085

Phone

(509) 967-2225

NPI assigned

Oct 25, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1124782271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57807 N SWEETWATER PR NE",
            "city": "BENTON CITY",
            "state": "WA",
            "postal_code": "993209515",
            "telephone_number": "424-252-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4791 W VAN GIESEN ST",
            "city": "WEST RICHLAND",
            "state": "WA",
            "postal_code": "993535085",
            "telephone_number": "509-967-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESS",
        "first_name": "PANDORA",
        "middle_name": "JUSTINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "61104204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSAGE THERAPIST",
            "identifier": "61104204",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lane
• Desiree Lang
• Amy Larsen, PA-C
• Trevor Larson, DDS
• Ryan Kirk Law, PA-C
• Wei-Hsung Lin, MD
• Lisa Marie PLLC
• Kindra Llamas
• Trevor Lott, D.O.
• Jason Madsen, DDS

• Massage Therapist in West Richland, WA
• Providers in West Richland, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.