Active NPI
Nicole M Gleeson, LMP
- Mechanotherapist
- Montesano, WA
National Provider Identifier
1487986915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- MA60112062
- Practice address
- 330 Pioneer Ave
Montesano, WA 98563 - Phone
- (360) 580-1667
- NPI assigned
- Feb 9, 2010
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | MA60112062 | WA | Primary |
Addresses
Primary practice location
330 Pioneer Ave
Montesano, WA 98563
Mailing address
103 York Drive
Aberdeen, WA 98520
Phone (360) 580-1667
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA60112062 | Other | WA | WA STATE MASSAGE LICENSE NUMBER |
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 |
|---|---|---|---|
| MA60112062 | WA | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1265673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587945600000",
"number": "1487986915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 YORK DRIVE",
"city": "ABERDEEN",
"state": "WA",
"postal_code": "98520",
"telephone_number": "360-580-1667"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 PIONEER AVE",
"city": "MONTESANO",
"state": "WA",
"postal_code": "98563",
"telephone_number": "360-580-1667"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLEESON",
"first_name": "NICOLE",
"middle_name": "M",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-09",
"last_updated": "2020-04-27",
"certification_date": "2020-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "WA",
"license": "MA60112062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA STATE MASSAGE LICENSE NUMBER",
"identifier": "MA60112062",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montesano, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 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.