Active NPI
Kimberly Moynihan
- Massage Therapist
- Melbourne, FL
National Provider Identifier
1053130328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA88837
- Practice address
- 1600 W Eau Gallie Blvd Ste 203
Melbourne, FL 32935-4149 - Phone
- (321) 987-0041
- NPI assigned
- Oct 4, 2024
- Last updated
- Oct 4, 2024
- Sex
- Female
- Sole proprietor
- No
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 | MA88837 | FL | Primary |
Addresses
Primary practice location
1600 W Eau Gallie Blvd Ste 203
Melbourne, FL 32935-4149
Mailing address
670 Caballero Ave SE
Palm Bay, FL 32909-4325
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 |
|---|---|---|---|
| MA88837 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lunella Enterprises | Massage Therapist | Current | Accepting new patients |
Locations
1600 W Eau Gallie Blvd
Ste 203
Melbourne, FL 32935
Phone (321) 987-0041
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728000000000",
"number": "1053130328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 CABALLERO AVE SE",
"city": "PALM BAY",
"state": "FL",
"postal_code": "329094325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 W EAU GALLIE BLVD STE 203",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329354149",
"telephone_number": "321-987-0041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOYNIHAN",
"first_name": "KIMBERLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-04",
"last_updated": "2024-10-04",
"certification_date": "2024-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA88837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.