Active NPI
Samdap Vanna Ly, MT
- Massage Therapist
- Seattle, WA
National Provider Identifier
1932680089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 60880040
- Practice address
- 916 NE 65TH St
Seattle, WA 98115-5542 - Phone
- (206) 267-0863
- NPI assigned
- Aug 27, 2018
- Sex
- Male
- Sole proprietor
- No
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 | 60880040 | WA | Primary |
Addresses
Primary practice location
916 NE 65TH St
Seattle, WA 98115-5542
Mailing address
4424 S Camano PL
Seattle, WA 98118-4627
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60880040 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1535328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1535328000000",
"number": "1932680089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4424 S CAMANO PL",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981184627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 NE 65TH ST",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981155542",
"telephone_number": "206-267-0863"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "SAMDAP",
"middle_name": "VANNA",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-27",
"last_updated": "2018-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "60880040",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 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.