Deena Y Gerasimov

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60689818 Issued in WA

Practice address

14415 74TH Street CT E
Sumner, WA 98390-8274

Phone

(253) 245-8914

NPI assigned

Jan 30, 2017

Sex

Female

Sole proprietor

Yes

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 30, 2017.

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1669919551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14415 74TH STREET CT E",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983908274",
            "telephone_number": "253-245-8914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14415 74TH STREET CT E",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983908274",
            "telephone_number": "253-245-8914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERASIMOV",
        "first_name": "DEENA",
        "middle_name": "Y",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60689818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MA60689818",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; 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.