Evelyn C De Jesus
Individual provider Active NPI Massage Therapist · Roy, WA
NPI 1477079010 · NPPES record last updated Aug 15, 2017
Key facts
- NPI
- 1477079010
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MA00013903 (WA)
- Practice address
- 29714 2ND Ave S
Roy, WA 98580-9598 - Phone
- (253) 219-4261
- NPI assigned
- Aug 15, 2017
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00013903 | WA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA00013903 | WA | Yes |
Addresses
Primary practice location
29714 2ND Ave S
Roy, WA 98580-9598
Mailing address
PO Box 1001
Spanaway, WA 98387-1001
Phone (253) 219-4261
Other providers in Roy, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.