Active NPI
Shannon Elise Bennett, LMT, CD(DONA)
- Massage Therapist
- Lacey, WA
National Provider Identifier
1487419883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61510001
- Practice address
- 7305 Radius Loop SE
Lacey, WA 98513-5008 - Phone
- (302) 750-4937
- NPI assigned
- Feb 15, 2024
- 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 | MA61510001 | WA | Primary |
Addresses
Primary practice location
7305 Radius Loop SE
Lacey, WA 98513-5008
Mailing address
7305 Radius Loop SE
Lacey, WA 98513-5008
Phone (302) 750-4937
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 |
|---|---|---|---|
| MA61510001 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707955200000",
"number": "1487419883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7305 RADIUS LOOP SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985135008",
"telephone_number": "302-750-4937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7305 RADIUS LOOP SE",
"city": "LACEY",
"state": "WA",
"postal_code": "985135008",
"telephone_number": "302-750-4937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "SHANNON",
"middle_name": "ELISE",
"credential": "LMT, CD(DONA)",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-15",
"last_updated": "2024-02-15",
"certification_date": "2024-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61510001",
"primary": true
}
],
"identifiers": [],
"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 Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.