Active NPI
Trina Edelbrock, LMT
- Massage Therapist
- Monroe, WA
National Provider Identifier
1689407892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA61583377
- Practice address
- 202 W Main St
Monroe, WA 98272-1819 - Phone
- (425) 780-7070
- NPI assigned
- Aug 22, 2024
- 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 | MA61583377 | WA | Primary |
Addresses
Primary practice location
202 W Main St
Monroe, WA 98272-1819
Mailing address
13216 196TH Ave SE
Monroe, WA 98272-7868
Phone (425) 387-0105
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 |
|---|---|---|---|
| MA61583377 | WA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theta Enterprises LLC | Massage Therapist | Current | Accepting new patients |
Locations
202 W Main St
Monroe, WA 98272
Phone (425) 780-7070
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": "1724284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1689407892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13216 196TH AVE SE",
"city": "MONROE",
"state": "WA",
"postal_code": "982727868",
"telephone_number": "425-387-0105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 W MAIN ST",
"city": "MONROE",
"state": "WA",
"postal_code": "982721819",
"telephone_number": "425-780-7070"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDELBROCK",
"first_name": "TRINA",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-22",
"last_updated": "2024-08-22",
"certification_date": "2024-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA61583377",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.