Healthcare Provider Details

I. General information

NPI: 1477942860
Provider Name (Legal Business Name): JOHNATHAN STANLEY LMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 N STEVENS ST
TACOMA WA
98407-4636
US

IV. Provider business mailing address

8324 62ND AVE SW
LAKEWOOD WA
98499-2623
US

V. Phone/Fax

Practice location:
  • Phone: 253-759-1500
  • Fax:
Mailing address:
  • Phone: 253-592-4941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number60524204
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: