Individual provider Active NPI

Laurel Gardner, LMP

  • Massage Therapist
  • Mountlake Terrace, WA
National Provider Identifier
1396041406
Registry record updated Feb 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
60192461 Issued in WA
Practice address
21907 64TH Ave W Ste 110
Mountlake Terrace, WA 98043-2298
Phone
(425) 673-5220
NPI assigned
Feb 7, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 60192461 WA Primary

Addresses

Primary practice location

21907 64TH Ave W Ste 110
Mountlake Terrace, WA 98043-2298

Mailing address

21907 64TH Ave W Ste 110
Mountlake Terrace, WA 98043-2298

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

LicenseStateTypeSpecialty
60192461WAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Pain Free Move Well PastSince Apr 17, 2020 Accepting new patients
Mosaic Rehabilitation, Inc PastSince Apr 1, 2007 Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1297036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297036800000",
    "number": "1396041406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21907 64TH AVE W STE 110",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21907 64TH AVE W STE 110",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432298",
            "telephone_number": "425-673-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "LAUREL",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-07",
        "last_updated": "2011-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "60192461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mountlake Terrace, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2011; 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.