Jacklyn Rose Petretee

Primary specialty

Massage TherapistTaxonomy code 225700000X

Practice address

24850 E Stonecrest Ave
Liberty Lake, WA 99019-3403

Phone

(509) 230-4630

NPI assigned

Oct 18, 2017

Sex

Female

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

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508284800000",
    "number": "1255842134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24850 E STONECREST AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990193403",
            "telephone_number": "509-230-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24850 E STONECREST AVE",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990193403",
            "telephone_number": "509-230-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRETEE",
        "first_name": "JACKLYN",
        "middle_name": "ROSE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-18",
        "last_updated": "2017-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Morbeck Persondek, DO
• Geraldine Anne Peterdy, MD
• Noland Peterdy, PHARMD, JD, MBA
• Patrick C Peterson, PA-C
• Tyler Peterson Peterson
• Heather Pincelli
• Cheralee K Pinnock, LMP
• Hazel Floranda Porter, RPH
• Proactive Health Chiropractic, Corp
• Cyndi Rai, LMP

• Massage Therapist in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 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.