Jessica Laura Deroche, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA00012837 Issued in WA

Practice address

1940 116TH Ave NE Ste 100
Bellevue, WA 98004-3011

Phone

(425) 590-9208

Fax

(425) 480-3080

NPI assigned

Jul 24, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• NW Sports Rehab, Corp.

  dba NW Sports Rehab

  • Acupuncturist
  • Federal Way, WA
  • NPI 1679698518

  Massage Therapist

  NPD (past)

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1982626412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 116TH AVE NE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043011",
            "telephone_number": "425-590-9208",
            "fax_number": "425-480-3080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 116TH AVE NE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043011",
            "telephone_number": "425-590-9208",
            "fax_number": "425-480-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROCHE",
        "first_name": "JESSICA",
        "middle_name": "LAURA",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA00012837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF L & I",
            "identifier": "206189",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kam Derakshani, DDS
• Julie Deramo, LMP
• Tatjana Deretic, M.D.
• Dermatology Arts, PLLC (Dermatology Arts)
• Dermatopatholoty Northwest PLLC (Carlsen Histopath)
• Eric Derovanessian, D.D.S
• Nicolaas Piet Deruyter, MD
• Arzu Dervish
• Vicki A Deshazo
• Aarti R Deshpande, M.D.

• Massage Therapist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.