Bryana Park, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60795235 Issued in WA

Practice address

5610 176TH St E Ste D105
Puyallup, WA 98375-9305

Phone

(253) 271-6750

NPI assigned

Jan 29, 2020

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

Other names 1

• Bryana Derton Former name

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.

• Canyon Crossing Chiropractic PS

  • Preferred Provider Organization
  • Puyallup, WA
  • NPI 1659741858
  NPD

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

{
    "created_epoch": "1580256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1609407535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12113 122ND ST E APT 17",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983745288",
            "telephone_number": "520-425-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5610 176TH ST E STE D105",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983759305",
            "telephone_number": "253-271-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "BRYANA",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-29",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60795235",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRYANA",
            "last_name": "DERTON",
            "credential": "LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nisanth Panicker, M.S.,CCC-SLP
• Cassandra Papademetriou, PT
• Jeremy Thomas Pape
• Traci Marie Parham, PT
• Gena Paris
• Eunice Park, PA-C
• Hee DO Park, RPH
• Jason Ki Park, MSW
• Roy J Park, MD
• Tracey Park, DDS

• Massage Therapist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.