Micky Shane McCafferty, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61408846 Issued in WA

Practice address

501 E McLoughlin Blvd
Vancouver, WA 98663-3356

Phone

(360) 831-3834

NPI assigned

Sep 2, 2022

Last updated

Apr 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Amanda Hall, LMP

  dba Thrive Massage & Wellness

  • Massage Therapist
  • Vancouver, WA
  • NPI 1750887840
  NPD (past)
• RF Heikens Enterprises, Inc

  dba Elements Therapeutic Massage - Lake Oswego

  • Massage Therapist
  • Lake Oswego, OR
  • NPI 1124454160
  NPD (past)

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

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1760103212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 NE 109TH AVE UNIT 95",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986825721",
            "telephone_number": "360-989-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 E MCLOUGHLIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986633356",
            "telephone_number": "360-831-3834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCAFFERTY",
        "first_name": "MICKY",
        "middle_name": "SHANE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-09-02",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "26877",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61408846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makaela McBride
• Nicole McBride
• Sarah Ann McBride, PT
• William McBride, MD
• Damon E McBrinn, MD
• Dwain Gavin McCall, PA-C
• Katherene McCallister-Salisbury
• Gayle Patrice McCamley, CP00001641
• Hilary Jane McCann, PMHNP-BC, APRN
• Kate Elizabeth McCarn, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.

Verify at the official NPI Registry.