Evergreen Massage & Wellness

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

EVERGREEN MASSAGE & WELLNESS

Practice address

6808 220TH St SW Ste 203
Mountlake Terrace, WA 98043-2187

Phone

(425) 776-1056

NPI assigned

Mar 20, 2018

Organization subpart

No

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

Authorized official

Name

Jessie Yao Southwick

Title

Manager/Owner

Phone

(425) 776-1056

Specialties & licenses 1

Addresses

Other names 1

• Edmonds Massage Center Doing business as

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521504000000",
    "number": "1871097360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6808 220TH ST SW STE 203",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6808 220TH ST SW STE 203",
            "city": "MOUNTLAKE TERRACE",
            "state": "WA",
            "postal_code": "980432187",
            "telephone_number": "425-776-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN MASSAGE & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-03-20",
        "status": "A",
        "authorized_official_last_name": "SOUTHWICK",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_middle_name": "YAO",
        "authorized_official_title_or_position": "MANAGER/OWNER",
        "authorized_official_telephone_number": "425-776-1056"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edmonds Massage Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William B. Ericson Jr., M.D.
• Jeffrey Clark Ernst, MD
• Sven Magnus Essle Brantaeng, MA
• Ets Consulting LLC
• Ets Consulting, LLC
• Evolvwell Ecounseling & Supervision, PLLC
• Ryan Factory
• Giselle Falkenberg, MD
• Wen-CHI Fan, APRN
• Margaret Farah

• Physical Medicine & Rehabilitation Physician in Mountlake Terrace, WA
• Providers in Mountlake Terrace, WA by specialty
• Physical Medicine & Rehabilitation Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; 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.