Active NPI
Autumn Lukezech
- Massage Therapist
- Sandpoint, ID
National Provider Identifier
1134638521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-2902
- Practice address
- 102 S Euclid Ave Ste 111
Sandpoint, ID 83864-4916 - Phone
- (512) 516-9144
- NPI assigned
- Sep 28, 2017
- 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 | MAS-2902 | ID | Primary |
Addresses
Primary practice location
102 S Euclid Ave Ste 111
Sandpoint, ID 83864-4916
Mailing address
33071 Highway 200
Sandpoint, ID 83864-9066
Phone (512) 516-9144
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 |
|---|---|---|---|
| MAS-2902 | ID | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ckam Rejuvenation Center LLC | Massage Therapist | Current | 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.
-
dba Aiyanna Wellness Day Spa
- Massage Therapist
- Ponderay, ID
- NPI 1699309963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506556800000",
"number": "1134638521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33071 HIGHWAY 200",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838649066",
"telephone_number": "512-516-9144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 S EUCLID AVE STE 111",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838644916",
"telephone_number": "512-516-9144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUKEZECH",
"first_name": "AUTUMN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-28",
"last_updated": "2017-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-2902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.