Douglas Lee Black, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00011374 Issued in WA

Practice address

16906 SE 1St St Ste 103
Vancouver, WA 98684-8512

Phone

(360) 903-9963

NPI assigned

Mar 31, 2007

Sex

Male

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NW Massage Therapy Corp

  • Massage Therapist
  • Vancouver, WA
  • NPI 1255852117

  Single Specialty

  NPD (past) Authorized official

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

{
    "created_epoch": "1175299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295855138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 NE 162ND AVE STE 611",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986823899",
            "telephone_number": "360-903-9963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16906 SE 1ST ST STE 103",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986848512",
            "telephone_number": "360-903-9963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6700 NE 162nd Ave Ste 415",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986823863",
            "country_code": "US",
            "telephone_number": "360-903-9963",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "DOUGLAS",
        "middle_name": "LEE",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00011374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Black Men & Women in Training LLC
• Libby Black-Walker
• Casey Black
• Dana M Black
• David John Black, MD, MPH
• Peter K Black, MD
• Rebecca Sarah Rose Black
• Sara Black, LMT
• Stephen Rockwell Black, LMHCA
• Timothy Black, PA

• Massage Therapist in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.