Active NPI
Kelly Jo McCulloch, LMT
- Massage Therapist
- Great Falls, MT
National Provider Identifier
1093341471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- LMT-LIC-1384
- Practice address
- 2509 7TH Ave S C-3
Great Falls, MT 59405-3031 - Phone
- (406) 868-8046
- Fax
- (406) 771-6883
- NPI assigned
- Mar 18, 2020
- 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 | LMT-LIC-1384 | MT | Primary |
Addresses
Primary practice location
2509 7TH Ave S C-3
Great Falls, MT 59405-3031
Mailing address
5030 71St Ave SW
Great Falls, MT 59404-5286
Phone (406) 868-8046
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 |
|---|---|---|---|
| LMT-LIC-1384 | MT | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584489600000",
"number": "1093341471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5030 71ST AVE SW",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594045286",
"telephone_number": "406-868-8046",
"fax_number": "406-771-6883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2509 7TH AVE S C-3",
"city": "GREAT FALLS",
"state": "MT",
"postal_code": "594053031",
"telephone_number": "406-868-8046",
"fax_number": "406-771-6883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCULLOCH",
"first_name": "KELLY",
"middle_name": "JO",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-18",
"last_updated": "2020-03-18",
"certification_date": "2020-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MT",
"license": "LMT-LIC-1384",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Great Falls, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.