Carrie A Tavares, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00012196 Issued in WA

Practice address

9623 32ND St SE Ste 117&118
Lake Stevens, WA 98258-5779

Phone

(206) 660-8500

Fax

(425) 320-4091

NPI assigned

Mar 15, 2017

Last updated

Feb 19, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Carrie A Tavares,LMT Professional name

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": "1489536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1437690039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6822 279TH ST NW",
            "city": "STANWOOD",
            "state": "WA",
            "postal_code": "982926041",
            "telephone_number": "206-660-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9623 32ND ST SE STE 117&118",
            "city": "LAKE STEVENS",
            "state": "WA",
            "postal_code": "982585779",
            "telephone_number": "206-660-8500",
            "fax_number": "425-320-4091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4322 Rucker Ave",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982032233",
            "country_code": "US",
            "telephone_number": "206-619-4122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAVARES",
        "first_name": "CARRIE",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-15",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00012196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAKESIDE MASSAGE AND WELLNESS STUDIO",
            "identifier": "604525883",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARRIE",
            "last_name": "TAVARES,LMT",
            "middle_name": "A",
            "credential": "LMT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Massage Therapist in Lake Stevens, WA
• Providers in Lake Stevens, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.