Lacy Juanella Wagner, MASSAGE THERAPIST

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61205126 Issued in WA

Practice address

3908 Creekside Loop Ste 110
Yakima, WA 98902-4858

Phone

(509) 571-1081

NPI assigned

Nov 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1637625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1376200410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 W ORCHARD AVE",
            "city": "SELAH",
            "state": "WA",
            "postal_code": "989421266",
            "telephone_number": "509-949-2916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3908 CREEKSIDE LOOP STE 110",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024858",
            "telephone_number": "509-571-1081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LACY",
        "middle_name": "JUANELLA",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-23",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61205126",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@muscle-release.com",
            "affiliation": "N",
            "endpointDescription": "clinic email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3908 Creekside Loop Ste 110",
            "city": "Yakima",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989024858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michael Wadlow
• Kendra Wagar
• Adam Richard Waggoner, DO
• Jennifer A Wagner, RN00154307
• Joanna Beata Wagner, PHARMACIST
• Sylena Wagner, SUDPT
• Wint Su Wai, M.D
• Joshua Michael Waits, LPN
• Wal-Mart Stores, Inc
• Wal-Mart Stores, Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; 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.