Active NPI
Lisa Larae Stam
- Massage Therapist
- Vancouver, WA
National Provider Identifier
1992724850
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 00019362
- Practice address
- 410 E 20TH St
Suite #7
Vancouver, WA 98663 - Phone
- (360) 608-1806
- Fax
- (360) 253-3047
- NPI assigned
- Jul 19, 2006
- Sex
- Female
- 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 | 00019362 | WA | Primary |
Addresses
Primary practice location
410 E 20TH St
Suite #7
Vancouver, WA 98663
Mailing address
17906 SE 16TH St
Vancouver, WA 98683
Phone (360) 608-1806
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 |
|---|---|---|---|
| 00019362 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992724850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17906 SE 16TH ST",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98683",
"telephone_number": "360-608-1806",
"fax_number": "360-253-3047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 E 20TH ST",
"address_2": "SUITE #7",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "98663",
"telephone_number": "360-608-1806",
"fax_number": "360-253-3047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAM",
"first_name": "LISA",
"middle_name": "LARAE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "00019362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vancouver, 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.