Active NPI
Corey Glen Davidson
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1447753702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 60656485
- Practice address
- 100 E 13TH St Ste 111
Vancouver, WA 98660-3329 - Phone
- (360) 521-6090
- NPI assigned
- Mar 13, 2018
- Last updated
- Mar 13, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 60656485 | WA | Primary |
Addresses
Primary practice location
100 E 13TH St Ste 111
Vancouver, WA 98660-3329
Mailing address
11018 NE 98TH St
Vancouver, WA 98662-2274
Phone (360) 213-9405
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 |
|---|---|---|---|
| 60656485 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Massage LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Massage Therapist
- Vancouver, WA
- NPI 1699272260
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520899200000",
"number": "1447753702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11018 NE 98TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986622274",
"telephone_number": "360-213-9405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E 13TH ST STE 111",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986603329",
"telephone_number": "360-521-6090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "COREY",
"middle_name": "GLEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-13",
"last_updated": "2018-03-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "60656485",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, WA
- David W Agnor PHD PC (Senior Connections)
- David W Agnor PHD PC (Senior Connections)
- David W Agnor PHD PC (Senior Connections)
- David W Agnor PHD PC Dba Senior Connections (Senior Connections)
- Autumn Nicole Davidson
- Gregory D Davidson, DPT
- Jacob Bryan Davidson
- Michael D Davidson, MSW, LICSW
- Sarah Jean Davidson, LMP
- Baylee Jo Marie Davies
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.