Active NPI
Kelly M Cavanaugh, LMT, CMLDT
- Massage Therapist
- Dyer, IN
National Provider Identifier
1073007548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT21505529
- Practice address
- 425 Joliet St Ste 212
Dyer, IN 46311-1766 - Phone
- (219) 381-9772
- NPI assigned
- Jun 19, 2018
- Last updated
- Jun 19, 2018
- 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 | MT21505529 | IN | Primary |
Addresses
Primary practice location
425 Joliet St Ste 212
Dyer, IN 46311-1766
Mailing address
618 214TH St
Dyer, IN 46311-1508
Phone (219) 381-9772
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 |
|---|---|---|---|
| MT21505529 | IN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529366400000",
"number": "1073007548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "618 214TH ST",
"city": "DYER",
"state": "IN",
"postal_code": "463111508",
"telephone_number": "219-381-9772"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 JOLIET ST STE 212",
"city": "DYER",
"state": "IN",
"postal_code": "463111766",
"telephone_number": "219-381-9772"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVANAUGH",
"first_name": "KELLY",
"middle_name": "M",
"credential": "LMT, CMLDT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-06-19",
"last_updated": "2018-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT21505529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dyer, IN
- C.L.O. Psychological, Serv.
- Timothy Caballero
- Cannan Healthcare Services & Staffing Inc
- Cardiospecialists Group, LTD (Midwest Arrhythmia Consultants)
- Bethany Lynn Casson, LMHC, LCPC
- Thomas J Cavanaugh, LMT
- Joseph E Chamberlain, LCSW
- Tae'Ni Chang-Stroman, M.D.
- Mark K Chang, M.D.
- Chariot of Hearts Transportation Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.