Active NPI
Kelly Mathis
- Massage Therapist
- Rock Springs, WY
National Provider Identifier
1104436211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 617 Broadway St Ste C
Rock Springs, WY 82901-6380 - Phone
- (307) 382-8661
- NPI assigned
- Aug 4, 2020
- Sex
- Male
- 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 | Primary |
Addresses
Primary practice location
617 Broadway St Ste C
Rock Springs, WY 82901-6380
Mailing address
3448 Dover Ave
Rock Springs, WY 82901-5776
Phone (307) 389-8953
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596499200000",
"number": "1104436211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3448 DOVER AVE",
"city": "ROCK SPRINGS",
"state": "WY",
"postal_code": "829015776",
"telephone_number": "307-389-8953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 BROADWAY ST STE C",
"city": "ROCK SPRINGS",
"state": "WY",
"postal_code": "829016380",
"telephone_number": "307-382-8661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHIS",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-04",
"last_updated": "2020-08-04",
"certification_date": "2020-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Springs, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.