Evergreen Massage Therapy, PS

Primary specialty

SpecialistTaxonomy code 174400000X

License

MA00016443 Issued in WA

Legal business name

EVERGREEN MASSAGE THERAPY, PS

Practice address

1048 W James St Ste 104
Kent, WA 98032-4600

Phone

(253) 850-2800

Fax

(253) 850-2805

NPI assigned

Feb 6, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Teri Green, LMP

Title

Owner/Licensed Massage Therapist

Phone

(253) 850-2800

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeong Bum Lee, LMP

  • Specialist
  • Kent, WA
  • NPI 1649571944
  NPD (past)

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

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1184996159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1048 W JAMES ST STE 104",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980324600",
            "telephone_number": "253-850-2800",
            "fax_number": "253-850-2805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1048 W JAMES ST STE 104",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980324600",
            "telephone_number": "253-850-2800",
            "fax_number": "253-850-2805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MASSAGE THERAPY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-06",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "OWNER/LICENSED MASSAGE THERAPIST",
        "authorized_official_telephone_number": "253-850-2800",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMP"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "MA00016443",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1568786531",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851442354",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1548402183",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1003032434",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1649571944",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1790833879",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1992862007",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Susanna Everly
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• Excel Public Charter School

• Specialist in Kent, WA
• Providers in Kent, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; 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.