Jereck Carmona

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61161777 Issued in WA

Practice address

4520 Intelco Loop SE Ste 4E
Lacey, WA 98503-6012

Phone

(360) 402-6776

Fax

(360) 347-1850

NPI assigned

May 17, 2021

Last updated

May 17, 2021By the provider in NPPES

Sex

Male

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

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

{
    "created_epoch": "1621209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1629642343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9083 WYATT CT SE",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "98501",
            "telephone_number": "253-820-6521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 INTELCO LOOP SE STE 4E",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036012",
            "telephone_number": "360-402-6776",
            "fax_number": "360-347-1850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARMONA",
        "first_name": "JERECK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-17",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61161777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Breanna Carrington

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; 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.