NPIMap

Organization Active NPI

Bonney Lake Clinical Massage LLC

  • Massage Therapist
  • Bonney Lake, WA
National Provider Identifier
1356672216
Registry record updated Jan 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Legal business name
BONNEY LAKE CLINICAL MASSAGE LLC
Practice address
21157 State Route 410 E
Bonney Lake, WA 98391-8457
Phone
(253) 862-4441
NPI assigned
Jan 15, 2010
Last updated
Jan 15, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristen Sisco
Title
Member LLC
Phone
(253) 862-4441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X Primary

Addresses

Primary practice location

21157 State Route 410 E
Bonney Lake, WA 98391-8457

Mailing address

PO Box 757
Enumclaw, WA 98022-0757
Phone (253) 862-4441

National Provider Directory

National Provider Directory

Locations

21157 State Route 410 E
Bonney Lake, WA 98391
Phone (253) 862-2138

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263513600000",
    "number": "1356672216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 757",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980220757",
            "telephone_number": "253-862-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21157 STATE ROUTE 410 E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983918457",
            "telephone_number": "253-862-4441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEY LAKE CLINICAL MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2010-01-15",
        "status": "A",
        "authorized_official_last_name": "SISCO",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "MEMBER LLC",
        "authorized_official_telephone_number": "253-862-4441"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2010; 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.