Active NPI
Bobbi Deardorff, MA-61094684
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1548860117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA-61094684
- Practice address
- 204 E 16TH St
Vancouver, WA 98663-3409 - Phone
- (360) 635-3477
- NPI assigned
- Oct 31, 2020
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA-61094684 | WA | Primary |
Addresses
Primary practice location
204 E 16TH St
Vancouver, WA 98663-3409
Mailing address
3407 NE 132ND Ave
Vancouver, WA 98682-7643
Phone (814) 777-4415
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | IntakeQ |
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 |
|---|---|---|---|
| MA-61094684 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| At Vancouver Massage, LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604102400000",
"number": "1548860117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3407 NE 132ND AVE",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986827643",
"telephone_number": "814-777-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 E 16TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986633409",
"telephone_number": "360-635-3477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEARDORFF",
"first_name": "BOBBI",
"credential": "MA-61094684",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-31",
"last_updated": "2020-10-31",
"certification_date": "2020-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA-61094684",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "IntakeQ",
"affiliation": "N",
"address_1": "204 E 16th St",
"city": "Vancouver",
"state": "WA",
"country_code": "US",
"postal_code": "986633409",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Vancouver, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.