Individual provider Active NPI

Lynne M Dittemore, LMP

  • Massage Therapist
  • Federal Way, WA
National Provider Identifier
1679798227
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA00014215 Issued in WA
Practice address
30821 Pacific Hwy S
Ste, a
Federal Way, WA 98003-4901
Phone
(253) 839-8608
Fax
(253) 941-6821
NPI assigned
Apr 16, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA00014215 WA Primary

Addresses

Primary practice location

30821 Pacific Hwy S
Ste, a
Federal Way, WA 98003-4901

Mailing address

30821 Pacific Hwy S
Ste, a
Federal Way, WA 98003-4901
Phone (253) 839-8608

Other identifiers 1

IdentifierTypeStateIssuer
0193127OtherWADEPT OF L&I

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

LicenseStateTypeSpecialty
MA00014215WAMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679798227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30821 PACIFIC HWY S",
            "address_2": "STE, A",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034901",
            "telephone_number": "253-839-8608",
            "fax_number": "253-941-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30821 PACIFIC HWY S",
            "address_2": "STE, A",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980034901",
            "telephone_number": "253-839-8608",
            "fax_number": "253-941-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DITTEMORE",
        "first_name": "LYNNE",
        "middle_name": "M",
        "credential": "LMP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00014215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L&I",
            "identifier": "0193127",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, 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.

Verify at the official NPI Registry.