Active NPI
Stephanie Lyn Petersen, LMT
- Massage Therapist
- Yelm, WA
National Provider Identifier
1972271328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA00012013
- Practice address
- 1412 Yelm Ave E Ste C101
Yelm, WA 98597-8328 - Phone
- (360) 458-7533
- NPI assigned
- Sep 1, 2021
- 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 | MA00012013 | WA | Primary |
Addresses
Primary practice location
1412 Yelm Ave E Ste C101
Yelm, WA 98597-8328
Mailing address
PO Box 674
Rainier, WA 98576-0674
Phone (801) 671-7221
Other practice location 1
16443 Woodbrook Lane SE
Rainier, WA 98576
Phone (801) 671-7221
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 |
|---|---|---|---|
| MA00012013 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630454400000",
"number": "1972271328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 674",
"city": "RAINIER",
"state": "WA",
"postal_code": "985760674",
"telephone_number": "801-671-7221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1412 YELM AVE E STE C101",
"city": "YELM",
"state": "WA",
"postal_code": "985978328",
"telephone_number": "360-458-7533"
}
],
"practiceLocations": [
{
"address_1": "16443 Woodbrook Lane SE",
"address_purpose": "LOCATION",
"city": "Rainier",
"state": "WA",
"postal_code": "98576",
"country_code": "US",
"telephone_number": "801-671-7221",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "STEPHANIE",
"middle_name": "LYN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-09-01",
"last_updated": "2021-09-01",
"certification_date": "2021-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA00012013",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yelm, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.