Active NPI
Kristen Jacob, LMT
- Massage Therapist
- University Place, WA
National Provider Identifier
1801437579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60971372
- Practice address
- 4114 Bridgeport Way W
University Place, WA 98466-4315 - Phone
- (253) 564-8100
- Fax
- (253) 564-8387
- NPI assigned
- Oct 3, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 | MA60971372 | WA | Primary |
Addresses
Primary practice location
4114 Bridgeport Way W
University Place, WA 98466-4315
Mailing address
16 Point Fosdick Dr NW
Gig Harbor, WA 98335-7819
Phone (859) 967-4447
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 |
|---|---|---|---|
| MA60971372 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1570060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570060800000",
"number": "1801437579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16 POINT FOSDICK DR NW",
"city": "GIG HARBOR",
"state": "WA",
"postal_code": "983357819",
"telephone_number": "859-967-4447"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4114 BRIDGEPORT WAY W",
"city": "UNIVERSITY PLACE",
"state": "WA",
"postal_code": "984664315",
"telephone_number": "253-564-8100",
"fax_number": "253-564-8387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACOB",
"first_name": "KRISTEN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-10-03",
"last_updated": "2019-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60971372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in University Place, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.