Active NPI
Kyle Henry Brockmann, LMT
- Massage Therapist
- Lake Hopatcong, NJ
National Provider Identifier
1023514353
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18KT01055300
- Practice address
- 3 Jerry Dr
Lake Hopatcong, NJ 07849-1416 - Phone
- (570) 228-1446
- NPI assigned
- Apr 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
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 | 18KT01055300 | NJ | Primary |
Addresses
Primary practice location
3 Jerry Dr
Lake Hopatcong, NJ 07849-1416
Mailing address
3 Jerry Dr
Lake Hopatcong, NJ 07849-1416
Phone (570) 228-1446
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 |
|---|---|---|---|
| 18KT01055300 | NJ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522800000000",
"number": "1023514353",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 JERRY DR",
"city": "LAKE HOPATCONG",
"state": "NJ",
"postal_code": "078491416",
"telephone_number": "570-228-1446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 JERRY DR",
"city": "LAKE HOPATCONG",
"state": "NJ",
"postal_code": "078491416",
"telephone_number": "570-228-1446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKMANN",
"first_name": "KYLE",
"middle_name": "HENRY",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-04-04",
"last_updated": "2018-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "NJ",
"license": "18KT01055300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Hopatcong, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.