Active NPI
Dedera A Midderhoff, LMP
- Massage Therapist
- Puyallup, WA
National Provider Identifier
1871635003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00020763
- Practice address
- 4111 S. Meridian
Suite F
Puyallup, WA 98374 - Phone
- (253) 273-2792
- NPI assigned
- Feb 13, 2007
- 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 | MA00020763 | WA | Primary |
Addresses
Primary practice location
4111 S. Meridian
Suite F
Puyallup, WA 98374
Mailing address
12310 109TH Ave CT E
Puyallup, WA 98374
Phone (253) 273-2792
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 |
|---|---|---|---|
| MA00020763 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1871635003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12310 109TH AVE CT E",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98374",
"telephone_number": "253-273-2792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4111 S. MERIDIAN",
"address_2": "SUITE F",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98374",
"telephone_number": "253-273-2792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDERHOFF",
"first_name": "DEDERA",
"middle_name": "A",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00020763",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, 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.