NPIMap

Individual provider Active NPI

Kyle S Bristow, LMP

  • Massage Therapist
  • Fircrest, WA
National Provider Identifier
1245508498
Registry record updated Apr 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA60141206 Issued in WA
Practice address
1033 Regents Blvd
Suite 204
Fircrest, WA 98466-6045
Phone
(253) 564-1288
Fax
(253) 564-1752
NPI assigned
Dec 2, 2011
Last updated
Apr 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA60141206 WA Primary

Addresses

Primary practice location

1033 Regents Blvd
Suite 204
Fircrest, WA 98466-6045

Mailing address

1033 Regents Blvd
Suite 204
Fircrest, WA 98466-6045
Phone (253) 564-1288

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

LicenseStateTypeSpecialty
MA60141206WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Austin D McMillin DC PS 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1322784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333497600000",
    "number": "1245508498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD",
            "address_2": "SUITE 204",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666045",
            "telephone_number": "253-564-1288",
            "fax_number": "253-564-1752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 REGENTS BLVD",
            "address_2": "SUITE 204",
            "city": "FIRCREST",
            "state": "WA",
            "postal_code": "984666045",
            "telephone_number": "253-564-1288",
            "fax_number": "253-564-1752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTOW",
        "first_name": "KYLE",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-02",
        "last_updated": "2012-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60141206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fircrest, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.