Carla Jean Vandenburgh, MASSAGE THERAPIST

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

217.011790 Issued in IL

Practice address

1600 Lebanon Ave Ste 101
Belleville, IL 62221-2491

Phone

(618) 978-7407

NPI assigned

Feb 20, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1361318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361318400000",
    "number": "1124368683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3212 HUNTERS WAY",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622213471",
            "telephone_number": "618-978-7407",
            "fax_number": "618-277-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 LEBANON AVE STE 101",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622212491",
            "telephone_number": "618-978-7407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDENBURGH",
        "first_name": "CARLA",
        "middle_name": "JEAN",
        "name_prefix": "Ms.",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-20",
        "last_updated": "2013-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "217.011790",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul Jack Utsler
• Nnenna Louisa Uzodi, MD, MPH
• Tessa Valdez, MS, ATC
• Ashleigh Lia Marie Valerius, SSP, NCSP
• Pamela Ann Van Bevern, PA-C, MPAS
• Raymond Glenn Varnum, RPH
• Vasantha Pai M.D. P.C.
• Vascular & Hand Surgery, LTD
• Alisa Vaughn
• Bridgette L Vaughn, NURSE PRACTITIONER

• Massage Therapist in Belleville, IL
• Providers in Belleville, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2013; 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.