{
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"NPI": "1316476112",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "CROSSFUNCTION SPORTS MASSAGE, PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "805 164TH ST SE STE 100",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MILL CREEK",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98012-6316",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "425-418-8588",
"MailingAddressFaxNumber": "425-595-3436",
"FirstLinePracticeLocationAddress": "805 164TH ST SE STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MILL CREEK",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98012-6316",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "425-418-8588",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/06/2017",
"LastUpdateDate": "05/29/2024",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MAPES",
"AuthorizedOfficialFirstName": "JENNY",
"AuthorizedOfficialMiddleName": "LYNN",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LMT",
"AuthorizedOfficialTelephoneNumber": "425-595-3436",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225700000X",
"TaxonomyName": "Massage Therapist",
"LicenseNumber": "MA60410229",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}