Active NPI
Victoria Ruth Pennock, CMT
- Massage Therapist
- Austin, TX
National Provider Identifier
1033371208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 108294
- Practice address
- 11308 Wet Season Dr
Austin, TX 78754-5855 - Phone
- (512) 906-9734
- NPI assigned
- Jun 30, 2008
- Sex
- Female
- 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 | 108294 | TX | Primary |
Addresses
Primary practice location
11308 Wet Season Dr
Austin, TX 78754-5855
Mailing address
5104 Fort Mason Dr
Austin, TX 78745-2313
Phone (512) 906-9734
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 |
|---|---|---|---|
| 108294 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1456272000000",
"number": "1033371208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5104 FORT MASON DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787452313",
"telephone_number": "512-906-9734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11308 WET SEASON DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787545855",
"telephone_number": "512-906-9734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNOCK",
"first_name": "VICTORIA",
"middle_name": "RUTH",
"name_prefix": "Mrs.",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-30",
"last_updated": "2016-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "108294",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.