Mindy Dawn Cervantes, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MAS-3001 Issued in ID

Practice address

4846 Hiram Ave
Chubbuck, ID 83202-3018

Phone

(435) 580-9461

NPI assigned

Jun 15, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Mindy Dawn Cervantes Former name

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.

• Idaho Sport Massage LLC

  • Massage Therapist
  • Pocatello, ID
  • NPI 1932946332

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1013692276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4846 HIRAM AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832023018",
            "telephone_number": "435-580-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4846 HIRAM AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832023018",
            "telephone_number": "435-580-9461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERVANTES",
        "first_name": "MINDY",
        "middle_name": "DAWN",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "ID",
            "license": "MAS-3001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MINDY",
            "last_name": "CERVANTES",
            "middle_name": "DAWN",
            "prefix": "MRS.",
            "credential": "MINDY STAUB, LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Massage Therapist in Chubbuck, ID
• Providers in Chubbuck, ID by specialty
• Massage Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.