Mako Bryant

Key facts

NPI

1154079176

Entity type

Individual (NPI type 1)

Primary specialty

Massage Therapist 225700000X

License

MA61235944 (WA)

Practice address

1129 W Main St Ste 172
Monroe, WA 98272-2034

Phone

(360) 863-0960

NPI assigned

Mar 17, 2022

Sex

Male

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2022.

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1154079176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20410 CORBRIDGE RD SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982729693",
            "telephone_number": "561-409-7879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 W MAIN ST STE 172",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982722034",
            "telephone_number": "360-863-0960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYANT",
        "first_name": "MAKO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61235944",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NONE",
            "identifier": "NONE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jennifer Estelle Bruner, LMP
• Ann Marie Buell I, PTA
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• Roxanne Catherine Burnsvatter, RNFA
• Christine Lynn Byrd, LMP

All providers in Monroe, WA · Massage Therapist in Washington