Active NPI
Glenda Hernandez
- Massage Therapist
- Everett, WA
National Provider Identifier
1184312886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61539492
- Practice address
- 15 SW Everett Mall Way Ste G
Everett, WA 98204-2715 - Phone
- (425) 355-5222
- Fax
- (425) 355-5231
- NPI assigned
- May 1, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 61539492 | WA | |
| Massage Therapist | 225700000X | MA90788 | FL | |
| Massage Therapist | 225700000X | MA61539492 | WA | Primary |
Addresses
Primary practice location
15 SW Everett Mall Way Ste G
Everett, WA 98204-2715
Mailing address
15 SW Everett Mall Way Ste G
Everett, WA 98204-2715
Phone (425) 355-5222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA90788 | FL | MD | Massage Therapist |
| 61539492 | WA | MD | Massage Therapist |
| MA61539492 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| C3 Wellness, LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba C3 Wellness Spa
- Multi-Specialty Clinic/Center
- Kissimmee, FL
- NPI 1811490287
Massage Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721692800000",
"number": "1184312886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 SW EVERETT MALL WAY STE G",
"city": "EVERETT",
"state": "WA",
"postal_code": "982042715",
"telephone_number": "425-355-5222",
"fax_number": "425-355-5231"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 SW EVERETT MALL WAY STE G",
"city": "EVERETT",
"state": "WA",
"postal_code": "982042715",
"telephone_number": "425-355-5222",
"fax_number": "425-355-5231"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERNANDEZ",
"first_name": "GLENDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-01",
"last_updated": "2024-07-23",
"certification_date": "2024-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "61539492",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA90788",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61539492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.