Active NPI
James Michael Roan Jr., LMT
- Massage Therapist
- Everett, WA
National Provider Identifier
1265277255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60211419
- Practice address
- 4322 Rucker Ave
Everett, WA 98203-2233 - Phone
- (425) 258-5454
- NPI assigned
- Jul 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
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 | MA60211419 | WA | Primary |
Addresses
Primary practice location
4322 Rucker Ave
Everett, WA 98203-2233
Mailing address
1303 25TH St Apt 304
Everett, WA 98201-5100
Phone (360) 502-1545
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 |
|---|---|---|---|
| MA60211419 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719792000000",
"number": "1265277255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1303 25TH ST APT 304",
"city": "EVERETT",
"state": "WA",
"postal_code": "982015100",
"telephone_number": "360-502-1545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4322 RUCKER AVE",
"city": "EVERETT",
"state": "WA",
"postal_code": "982032233",
"telephone_number": "425-258-5454"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROAN",
"first_name": "JAMES",
"middle_name": "MICHAEL",
"name_suffix": "Jr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-01",
"last_updated": "2024-07-01",
"certification_date": "2024-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60211419",
"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 1, 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.