Active NPI
Stephanie Mitchell, MMP, CRP
- Massage Therapist
- Roanoke, VA
National Provider Identifier
1073903126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0019012842
- Practice address
- 2105 Electric Rd
Suite 103
Roanoke, VA 24018-2315 - Phone
- (540) 400-0004
- NPI assigned
- Jan 28, 2015
- 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 | 0019012842 | VA | Primary |
Addresses
Primary practice location
2105 Electric Rd
Suite 103
Roanoke, VA 24018-2315
Mailing address
2621 Beverly Blvd SW
Roanoke, VA 24015-4023
Phone (540) 400-4980
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 |
|---|---|---|---|
| 0019012842 | VA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rehabilitative Connections | Massage Therapist | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422403200000",
"number": "1073903126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2621 BEVERLY BLVD SW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240154023",
"telephone_number": "540-400-4980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2105 ELECTRIC RD",
"address_2": "SUITE 103",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240182315",
"telephone_number": "540-400-0004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "STEPHANIE",
"name_prefix": "Mrs.",
"credential": "MMP, CRP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-28",
"last_updated": "2015-01-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "VA",
"license": "0019012842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.