Active NPI
Theresa G Lystad, L.M.P.
- Massage Therapist
- Spokane Valley, WA
National Provider Identifier
1669526372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00010270
- Practice address
- 12905 E Sprague Ave
Spokane Valley, WA 99216-0731 - Phone
- (509) 922-0303
- Fax
- (509) 922-0657
- NPI assigned
- Jan 22, 2007
- Sex
- Female
- 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 | MA00010270 | WA | Primary |
Addresses
Primary practice location
12905 E Sprague Ave
Spokane Valley, WA 99216-0731
Mailing address
12905 E Sprague Ave
Spokane Valley, WA 99216-0731
Phone (509) 922-0303
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8942606 | Other | WA | CRIME VICTIMS ID # |
| 5339L4 | Other | ASURIS PROVIDER ID # | |
| 0173324 | Other | WA | LABOR & INDUSTRIES |
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 |
|---|---|---|---|
| MA00010270 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spinal & Sports Care Clinic P S | 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": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669526372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12905 E SPRAGUE AVE",
"city": "SPOKANE VALLEY",
"state": "WA",
"postal_code": "992160731",
"telephone_number": "509-922-0303",
"fax_number": "509-922-0657"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12905 E SPRAGUE AVE",
"city": "SPOKANE VALLEY",
"state": "WA",
"postal_code": "992160731",
"telephone_number": "509-922-0303",
"fax_number": "509-922-0657"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYSTAD",
"first_name": "THERESA",
"middle_name": "G",
"credential": "L.M.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00010270",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS ID #",
"identifier": "8942606",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASURIS PROVIDER ID #",
"identifier": "5339L4",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0173324",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Spokane Valley, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.