NPIMap

Organization Active NPI

At Vancouver Massage, LLC

Doing business as At Vancouver Massage

  • Massage Therapist
  • Vancouver, WA
National Provider Identifier
1164926374
Registry record updated Oct 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA00019183 Issued in WA
Legal business name
AT VANCOUVER MASSAGE, LLC
Doing business as
At Vancouver Massage
Practice address
1508 Broadway St
Vancouver, WA 98663-3434
Phone
(360) 635-3477
Fax
(844) 682-7291
NPI assigned
Mar 21, 2018
Last updated
Oct 9, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2023

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

Authorized official

Name
Ms. Jean A Koncos, LMTNPI 1982906343
Title
Owner
Phone
(360) 635-3477

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA00019183 WA Primary

Addresses

Primary practice location

1508 Broadway St
Vancouver, WA 98663-3434

Mailing address

204 E 16TH St
Vancouver, WA 98663-3409
Phone (360) 635-3477

Other names 1

  • At Vancouver Massage Doing business as

National Provider Directory

National Provider Directory

Locations

1508 Broadway St
Vancouver, WA 98663
Phone (360) 635-3477

204 E 16th St
Vancouver, WA 98663
Phone (360) 326-3264

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1521590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696809600000",
    "number": "1164926374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 E 16TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633409",
            "telephone_number": "360-635-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 BROADWAY ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633434",
            "telephone_number": "360-635-3477",
            "fax_number": "844-682-7291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AT VANCOUVER MASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-21",
        "last_updated": "2023-10-09",
        "certification_date": "2023-10-09",
        "status": "A",
        "authorized_official_last_name": "KONCOS",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-635-3477",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00019183",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "At Vancouver Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 9, 2023; 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.