Active NPI
Angela Kristina Roberson, LMP
- Massage Therapist
- Lacey, WA
National Provider Identifier
1447369137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00019188
- Practice address
- 3439 Gonzaga CT SE
Lacey, WA 98503-6236 - Phone
- (360) 915-6540
- NPI assigned
- Aug 29, 2006
- 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 | MA00019188 | WA | Primary |
Addresses
Primary practice location
3439 Gonzaga CT SE
Lacey, WA 98503-6236
Mailing address
3439 Gonzaga CT SE
Lacey, WA 98503-6236
Phone (360) 915-6540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0204464 | Other | WA | DEPT OF L&I |
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 |
|---|---|---|---|
| MA00019188 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1447369137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3439 GONZAGA CT SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985036236",
"telephone_number": "360-915-6540"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3439 GONZAGA CT SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985036236",
"telephone_number": "360-915-6540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "ANGELA",
"middle_name": "KRISTINA",
"name_prefix": "Ms.",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00019188",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF L&I",
"identifier": "0204464",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.