Active NPI
Marcus Shamblin
- Massage Therapist
- Montgomery, IL
National Provider Identifier
1073282125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227020494
- Practice address
- 87 Saugatuck Rd
Montgomery, IL 60538-2441 - Phone
- (815) 341-1663
- NPI assigned
- Sep 11, 2021
- 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 | 227020494 | IL | Primary |
Addresses
Primary practice location
87 Saugatuck Rd
Montgomery, IL 60538-2441
Mailing address
87 Saugatuck Rd
Montgomery, IL 60538-2441
Phone (815) 341-1663
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL |
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 |
|---|---|---|---|
| 227020494 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631318400000",
"number": "1073282125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "87 SAUGATUCK RD",
"city": "MONTGOMERY",
"state": "IL",
"postal_code": "605382441",
"telephone_number": "815-341-1663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "87 SAUGATUCK RD",
"city": "MONTGOMERY",
"state": "IL",
"postal_code": "605382441",
"telephone_number": "815-341-1663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAMBLIN",
"first_name": "MARCUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-09-11",
"last_updated": "2021-09-11",
"certification_date": "2021-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "IL",
"license": "227020494",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Instagram",
"affiliation": "N",
"address_1": "87 Saugatuck Rd",
"city": "Montgomery",
"state": "IL",
"country_code": "US",
"postal_code": "605382441",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Montgomery, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.