Active NPI
Jeff Tissell, L.M.P.
- Massage Therapist
- Bothell, WA
National Provider Identifier
1619166451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00005339
- Practice address
- 18008 Bothell Everett Hwy
Unit F
Bothell, WA 98012-6842 - Phone
- (425) 830-9509
- NPI assigned
- Oct 17, 2007
- Sex
- Male
- 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 | MA00005339 | WA | Primary |
Addresses
Primary practice location
18008 Bothell Everett Hwy
Unit F
Bothell, WA 98012-6842
Mailing address
18606 10TH Ave SE
Bothell, WA 98012-9621
Phone (425) 830-9509
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 |
|---|---|---|---|
| MA00005339 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192579200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436313600000",
"number": "1619166451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18606 10TH AVE SE",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980129621",
"telephone_number": "425-830-9509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18008 BOTHELL EVERETT HWY",
"address_2": "UNIT F",
"city": "BOTHELL",
"state": "WA",
"postal_code": "980126842",
"telephone_number": "425-830-9509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISSELL",
"first_name": "JEFF",
"credential": "L.M.P.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-17",
"last_updated": "2015-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00005339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bothell, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.