Massage Evolution LLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

MASSAGE EVOLUTION LLC

Practice address

2615 Packerland Dr Ste F1
Green Bay, WI 54313-5780

Phone

(920) 288-1235

NPI assigned

Nov 21, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amy L Hacker, LMT

Title

Co-President

Phone

(920) 737-3452

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668988800000",
    "number": "1104535814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 PACKERLAND DR STE F1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135780",
            "telephone_number": "920-288-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2615 PACKERLAND DR STE F1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543135780",
            "telephone_number": "920-288-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAGE EVOLUTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-21",
        "last_updated": "2022-11-21",
        "certification_date": "2022-11-21",
        "status": "A",
        "authorized_official_last_name": "HACKER",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CO-PRESIDENT",
        "authorized_official_telephone_number": "920-737-3452",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Katherine Ann Massart
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• Katlyn Marie Mastel I, PHARMD

• Health Service Clinic/Center in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Health Service Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.