Active NPI
James Wagoner, LMP
- Massage Therapist
- Olympia, WA
National Provider Identifier
1497797120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 1800 Cooper Point Rd SW
#21
Olympia, WA 98502-1178 - Phone
- (360) 956-1100
- Fax
- (360) 956-1113
- NPI assigned
- Jun 10, 2006
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
1800 Cooper Point Rd SW
#21
Olympia, WA 98502-1178
Mailing address
5210 Corporate Center Loop SE
Suite D
Lacey, WA 98503-5952
Phone (360) 455-8155
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0211977 | Other | WA | DEPT. OF LABOR & INDUSTRY |
| 6619WA | Other | WA | REGENCE BLUE SHIELD |
| 8947908 | Other | WA | L&I CRIME VICTIMS |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232064000000",
"number": "1497797120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5210 CORPORATE CENTER LOOP SE",
"address_2": "SUITE D",
"city": "LACEY",
"state": "WA",
"postal_code": "985035952",
"telephone_number": "360-455-8155",
"fax_number": "360-455-1655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 COOPER POINT RD SW",
"address_2": "#21",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985021178",
"telephone_number": "360-956-1100",
"fax_number": "360-956-1113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "JAMES",
"credential": "LMP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2009-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT. OF LABOR & INDUSTRY",
"identifier": "0211977",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "6619WA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I CRIME VICTIMS",
"identifier": "8947908",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.