Active NPI
Susann Kristin Wadsworth, MA60036649
- Massage Therapist
- Coupeville, WA
National Provider Identifier
1962631580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60036649
- Practice address
- 504 N Main St
Coupeville, WA 98239-3422 - Phone
- (360) 630-0911
- Fax
- (360) 544-8748
- NPI assigned
- Jul 2, 2009
- 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 | MA60036649 | WA | Primary |
Addresses
Primary practice location
504 N Main St
Coupeville, WA 98239-3422
Mailing address
372 Arrowhead Beach Rd
Camano Island, WA 98282-8711
Phone (360) 630-0911
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 |
|---|---|---|---|
| MA60036649 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246492800000",
"number": "1962631580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "372 ARROWHEAD BEACH RD",
"city": "CAMANO ISLAND",
"state": "WA",
"postal_code": "982828711",
"telephone_number": "360-630-0911",
"fax_number": "360-544-8748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 N MAIN ST",
"city": "COUPEVILLE",
"state": "WA",
"postal_code": "982393422",
"telephone_number": "360-630-0911",
"fax_number": "360-544-8748"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADSWORTH",
"first_name": "SUSANN",
"middle_name": "KRISTIN",
"name_prefix": "Ms.",
"credential": "MA60036649",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-02",
"last_updated": "2009-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60036649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coupeville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.