Active NPI
Sean Derrick McDonald, MA
- Massage Therapist
- Lynnwood, WA
National Provider Identifier
1386005106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA 00021460
- Practice address
- 5919 203Rd St SW
Lynnwood, WA 98036-6218 - Phone
- (435) 951-9026
- NPI assigned
- Mar 8, 2016
- 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 | MA 00021460 | WA | Primary |
Addresses
Primary practice location
5919 203Rd St SW
Lynnwood, WA 98036-6218
Mailing address
5919 203Rd St SW
Lynnwood, WA 98036-6218
Phone (425) 951-9026
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00021460 | Other | WA | MASSAGE THERAPIST |
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 00021460 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457395200000",
"number": "1386005106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5919 203RD ST SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366218",
"telephone_number": "425-951-9026"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5919 203RD ST SW",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366218",
"telephone_number": "435-951-9026"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "SEAN",
"middle_name": "DERRICK",
"name_prefix": "Mr.",
"credential": "MA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-08",
"last_updated": "2016-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA 00021460",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPIST",
"identifier": "00021460",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.