NPIMap

Organization Active NPI

Clark Therapeutic Massage

  • Massage Therapist
  • Graham, WA
National Provider Identifier
1770620064
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA00004428 Issued in WA
Legal business name
CLARK THERAPEUTIC MASSAGE
Practice address
10107 213TH St E
Graham, WA 98338-8059
Phone
(253) 847-2687
Fax
(253) 846-3012
NPI assigned
Jan 30, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Linda Patricia Clark, LMP
Title
Owner
Phone
(253) 847-2687

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X MA00004428 WA Primary

Addresses

Primary practice location

10107 213TH St E
Graham, WA 98338-8059

Mailing address

PO Box 988
Graham, WA 98338-0988
Phone (253) 847-2687

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770620064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 988",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983380988",
            "telephone_number": "253-847-2687",
            "fax_number": "253-846-3012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10107 213TH ST E",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388059",
            "telephone_number": "253-847-2687",
            "fax_number": "253-846-3012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK THERAPEUTIC MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "PATRICIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-847-2687",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMP"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00004428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Graham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.