Active NPI
Kyle Jorgensen, LMT
- Massage Therapist
- Pullman, WA
National Provider Identifier
1609416478
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61031942
- Practice address
- 1256 SE Bishop Blvd Ste J
Pullman, WA 99163-5414 - Phone
- (509) 332-6506
- NPI assigned
- Jan 9, 2020
- 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 | MA61031942 | WA | Primary |
Addresses
Primary practice location
1256 SE Bishop Blvd Ste J
Pullman, WA 99163-5414
Mailing address
1256 SE Bishop Blvd Ste J
Pullman, WA 99163-5414
Phone (509) 332-6506
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 |
|---|---|---|---|
| MA61031942 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578528000000",
"number": "1609416478",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1256 SE BISHOP BLVD STE J",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635414",
"telephone_number": "509-332-6506"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1256 SE BISHOP BLVD STE J",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635414",
"telephone_number": "509-332-6506"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORGENSEN",
"first_name": "KYLE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-01-09",
"last_updated": "2020-01-09",
"certification_date": "2020-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61031942",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.