Dick Duane Pouliot, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

M00004930 Issued in WA

Practice address

1818 Grove St # a
Marysville, WA 98270-4330

Phone

(425) 280-1008

NPI assigned

Feb 14, 2007

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

Other identifiers 2

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": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164565701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10218 60TH ST SE",
            "city": "SNOHOMISH",
            "state": "WA",
            "postal_code": "982901016",
            "telephone_number": "425-280-1008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 GROVE ST # A",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982704330",
            "telephone_number": "425-280-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIOT",
        "first_name": "DICK",
        "middle_name": "DUANE",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "M00004930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I NUMBER",
            "identifier": "54890",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD NUM.",
            "identifier": "PO9881",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.