Active NPI
Denison F Wiedman, LMT
- Massage Therapist
- White Salmon, WA
National Provider Identifier
1407446412
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 61034962
- Practice address
- 136 N Main Ave
White Salmon, WA 98672-1149 - Phone
- (786) 271-2568
- NPI assigned
- Jan 23, 2021
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 25542 | OR | |
| Massage Therapist | 225700000X | 61034962 | WA | Primary |
Addresses
Primary practice location
136 N Main Ave
White Salmon, WA 98672-1149
Mailing address
PO Box 2290 PMB 204
White Salem, WA 98672
Phone (786) 271-2568
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 |
|---|---|---|---|
| 25542 | OR | MD | Massage Therapist |
| 61034962 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707696000000",
"number": "1407446412",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2290 PMB 204",
"city": "WHITE SALEM",
"state": "WA",
"postal_code": "98672",
"telephone_number": "786-271-2568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 N MAIN AVE",
"city": "WHITE SALMON",
"state": "WA",
"postal_code": "986721149",
"telephone_number": "786-271-2568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIEDMAN",
"first_name": "DENISON",
"middle_name": "F",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-23",
"last_updated": "2024-02-12",
"certification_date": "2024-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "25542",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "61034962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Salmon, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.