Active NPI
Laura Bergen, LMT
- Massage Therapist
- Lynnwood, WA
National Provider Identifier
1407591852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 4030 Alderwood Mall Blvd
Lynnwood, WA 98036-6763 - Phone
- (425) 776-0803
- NPI assigned
- Apr 30, 2022
- Sex
- Female
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
4030 Alderwood Mall Blvd
Lynnwood, WA 98036-6763
Mailing address
4030 Alderwood Mall Blvd
Lynnwood, WA 98036-6763
Phone (425) 776-0803
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Experience Momentum, Inc - Fremont | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1651276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651276800000",
"number": "1407591852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4030 ALDERWOOD MALL BLVD",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366763",
"telephone_number": "425-776-0803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4030 ALDERWOOD MALL BLVD",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980366763",
"telephone_number": "425-776-0803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGEN",
"first_name": "LAURA",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-30",
"last_updated": "2022-04-30",
"certification_date": "2022-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"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 Apr 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.