Active NPI
Declan Lough
- Massage Therapist
- Sacramento, CA
National Provider Identifier
1144799818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 76275
- Practice address
- 2322 Butano Dr Ste 214
Sacramento, CA 95825-0657 - Phone
- (916) 715-5755
- NPI assigned
- Nov 24, 2018
- Sex
- Male
- 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 | 76275 | CA | Primary |
Addresses
Primary practice location
2322 Butano Dr Ste 214
Sacramento, CA 95825-0657
Mailing address
2322 Butano Dr Ste 214
Sacramento, CA 95825-0657
Phone (191) 671-5575
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 76275 | Other | CA | CAMTC |
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 |
|---|---|---|---|
| 76275 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Body Fix Therapies Inc | Single Specialty | Past | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543017600000",
"number": "1144799818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2322 BUTANO DR STE 214",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958250657",
"telephone_number": "191-671-5575"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2322 BUTANO DR STE 214",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958250657",
"telephone_number": "916-715-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOUGH",
"first_name": "DECLAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-11-24",
"last_updated": "2018-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "76275",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAMTC",
"identifier": "76275",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.