Jessica D Sundahl, L.M.P

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00016460 Issued in WA

Practice address

4111 S Meridian
Suite 208
Puyallup, WA 98373-5973

Phone

(253) 905-5214

Fax

(253) 503-6146

NPI assigned

Jan 9, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Ms. Jessica D Tisch Professional name

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": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381190400000",
    "number": "1730238528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 97TH ST E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984465428",
            "telephone_number": "253-905-5214",
            "fax_number": "253-503-6146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 S MERIDIAN",
            "address_2": "SUITE 208",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983735973",
            "telephone_number": "253-905-5214",
            "fax_number": "253-503-6146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNDAHL",
        "first_name": "JESSICA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "L.M.P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2013-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00016460",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0158989",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBI BUSINESS",
            "identifier": "6021925760010001",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE FOR MASSAGE",
            "identifier": "MA00016460",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCECARE ID NUMBER",
            "identifier": "4342TI",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA PROVIDER NUMBER",
            "identifier": "254423100000",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "0007827360",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "TISCH",
            "middle_name": "D",
            "prefix": "MS.",
            "credential": "L.M.P",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; 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.