Active NPI
Shonelle Uilani Pascua Gongob, LMP
- Massage Therapist
- Lakewood, WA
National Provider Identifier
1245588490
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60290683
- Practice address
- 7308 Bridgeport Way W
Ste. 103
Lakewood, WA 98499-8000 - Phone
- (253) 582-8142
- Fax
- (253) 582-8160
- NPI assigned
- Aug 20, 2012
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA60290683 | WA | Primary |
Addresses
Primary practice location
7308 Bridgeport Way W
Ste. 103
Lakewood, WA 98499-8000
Mailing address
4040 Orchard St W
Ste. 100
Fircrest, WA 98466-6606
Phone (253) 564-1560
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 |
|---|---|---|---|
| MA60290683 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345420800000",
"number": "1245588490",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4040 ORCHARD ST W",
"address_2": "STE. 100",
"city": "FIRCREST",
"state": "WA",
"postal_code": "984666606",
"telephone_number": "253-564-1560",
"fax_number": "253-564-4449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7308 BRIDGEPORT WAY W",
"address_2": "STE. 103",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984998000",
"telephone_number": "253-582-8142",
"fax_number": "253-582-8160"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONGOB",
"first_name": "SHONELLE",
"middle_name": "UILANI PASCUA",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-20",
"last_updated": "2012-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60290683",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.