Active NPI
Charles Ryan Fetters, LMT
- Massage Therapist
- Renton, WA
National Provider Identifier
1346648367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60306672
- Practice address
- 704 S 3Rd St.
Suite B5
Renton, WA 98057-2553 - Phone
- (206) 581-6756
- NPI assigned
- Dec 8, 2014
- 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 | MA60306672 | WA | Primary |
Addresses
Primary practice location
704 S 3Rd St.
Suite B5
Renton, WA 98057-2553
Mailing address
1201 Thomas Lane
#6
Renton, WA 98055-3536
Phone (206) 696-3851
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 |
|---|---|---|---|
| MA60306672 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747353600000",
"number": "1346648367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 THOMAS LANE",
"address_2": "#6",
"city": "RENTON",
"state": "WA",
"postal_code": "980553536",
"telephone_number": "206-696-3851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 S 3RD ST.",
"address_2": "SUITE B5",
"city": "RENTON",
"state": "WA",
"postal_code": "980572553",
"telephone_number": "206-581-6756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETTERS",
"first_name": "CHARLES",
"middle_name": "RYAN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-12-08",
"last_updated": "2025-05-16",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60306672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Renton, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.