Malissa J Knobloch

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227017720 Issued in IL

Practice address

4 Yount Dr Ste 2
Bloomington, IL 61704-3737

Phone

(309) 660-6721

NPI assigned

Jun 12, 2020

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 identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591920000000",
    "number": "1043835242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 YOUNT DR STE 2",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 YOUNT DR STE 2",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043737",
            "telephone_number": "309-660-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOBLOCH",
        "first_name": "MALISSA",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-12",
        "last_updated": "2020-06-12",
        "certification_date": "2020-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227017720",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL MASSAGE",
            "identifier": "227017720",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "therapeuticbodywork@frontier.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "4 Yount Dr Ste 2",
            "city": "Bloomington",
            "state": "IL",
            "country_code": "US",
            "postal_code": "617043737",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kimberly A Klepec, MSW, LCSW
• Sharon J. Klingman, MS, CADC, LCPC
• Courtney Klokkenga, M.S. CCC-SLP/L
• Lawrence Kneezel, M.D.
• Sarah J Knight
• Jason Knox
• Karlee Knudsen
• Kelly Jo Knutson, PSY.D.
• Jennifer Elizabeth Koch, PSY.D.
• Shawn M Koehler, O.D.

• Massage Therapist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2020; 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.