Active NPI
Sunny Wallis Birdstone, LMP
- Massage Therapist
- Auburn, WA
National Provider Identifier
1861568883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA9942
- Practice address
- 821 Harvey Rd
Auburn, WA 98002-4225 - Phone
- (253) 833-1833
- Fax
- (253) 833-4642
- NPI assigned
- Nov 28, 2006
- 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 | MA9942 | WA | Primary |
Addresses
Primary practice location
821 Harvey Rd
Auburn, WA 98002-4225
Mailing address
3250 S 77TH St
Lot 8
Tacoma, WA 98409-5061
Phone (253) 473-3400
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0007372197 | Other | WA | AETNA |
| 218248218247 | Other | WA | PREMERA BLUE CROSS |
| 5316WA | Other | WA | REGENCE BLUE SHIELD |
| 0137636 | Other | WA | WA LABOR AND INDUSTRIES |
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 |
|---|---|---|---|
| MA9942 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861568883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3250 S 77TH ST",
"address_2": "LOT 8",
"city": "TACOMA",
"state": "WA",
"postal_code": "984095061",
"telephone_number": "253-473-3400",
"fax_number": "253-476-1530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 HARVEY RD",
"city": "AUBURN",
"state": "WA",
"postal_code": "980024225",
"telephone_number": "253-833-1833",
"fax_number": "253-833-4642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIRDSTONE",
"first_name": "SUNNY",
"middle_name": "WALLIS",
"name_prefix": "Ms.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-28",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA9942",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0007372197",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREMERA BLUE CROSS",
"identifier": "218248218247",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "5316WA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WA LABOR AND INDUSTRIES",
"identifier": "0137636",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Auburn, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.