Jaclyn June Monge Southard, LMT

Primary specialty

MechanotherapistTaxonomy code 172M00000X

License

MA00023326 Issued in WA

Practice address

4520 Intelco Loop SE BLDG 3
Lacey, WA 98503-6008

Phone

(360) 388-0485

Fax

(360) 890-4066

NPI assigned

Nov 16, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Massage Restoration LLC

  • Massage Therapist
  • Lacey, WA
  • NPI 1497359350
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606003200000",
    "number": "1497936546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9649 LOOKOUT DR NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985029757",
            "telephone_number": "360-388-0485",
            "fax_number": "360-890-4066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 INTELCO LOOP SE BLDG 3",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036008",
            "telephone_number": "360-388-0485",
            "fax_number": "360-890-4066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARD",
        "first_name": "JACLYN",
        "middle_name": "JUNE MONGE",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-16",
        "last_updated": "2020-11-22",
        "certification_date": "2020-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "WA",
            "license": "MA00023326",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sound Rehabilitation and Performance
• Sound Somatic Therapy, PLLC
• South Sound Adult Family Home LLC
• South Sound Audioloyg LLC
• Gregory South, PHARM D.
• Stacey M Sowders
• Chris John Spaccarotelli
• Stephanie Michelle Sparks, DPT
• Ashlee R Speed
• Justin Lee Speer, BA

• Mechanotherapist in Lacey, WA
• Providers in Lacey, WA by specialty
• Mechanotherapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.

Verify at the official NPI Registry.