Travis Edward Jackson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60689794 Issued in WA

Practice address

427 SW 152ND St Unit C
Burien, WA 98166-2208

Phone

(206) 787-0502

Fax

(206) 787-0502

NPI assigned

Dec 10, 2017

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.

• Integrum Healthcare LLC

  • Clinic/Center
  • Burien, WA
  • NPI 1619268802
  NPD (past)

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

{
    "created_epoch": "1512864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512864000000",
    "number": "1174038368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21609 6TH AVE S",
            "city": "NORMANDY PARK",
            "state": "WA",
            "postal_code": "981986114",
            "telephone_number": "206-878-0502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 SW 152ND ST UNIT C",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981662208",
            "telephone_number": "206-787-0502",
            "fax_number": "206-787-0502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "TRAVIS",
        "middle_name": "EDWARD",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-10",
        "last_updated": "2017-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60689794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Kim & M Cervantes-Kim DDS PLLC
• Fredric Neven Jackson, MD PS
• Jamain Jackson
• Jebryan Armani Jackson
• Tami Jackson, LMT
• Jacqueline Van Tran MD PS
• Jae Hong DDS, PLLC
• Jal, M.D., Inc., P.S.
• Jessica Jang
• Susan Janke, OTR

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2017; 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.