Active NPI
Justin McDonald, LMT, HBS, CFSC
- Massage Therapist
- Colorado Springs, CO
National Provider Identifier
1164031555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT.0022782
- Practice address
- 4740 Flintridge Dr Ste 130
Colorado Springs, CO 80918-4273 - Phone
- (719) 917-1000
- NPI assigned
- Jul 30, 2020
- 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 | MT.0022782 | CO | Primary |
Addresses
Primary practice location
4740 Flintridge Dr Ste 130
Colorado Springs, CO 80918-4273
Mailing address
3028 Deliverance Dr
Colorado Springs, CO 80918-1675
Phone (815) 540-1688
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 |
|---|---|---|---|
| MT.0022782 | CO | MD | Massage Therapist |
Interoperability endpoints
- https://api.platform.athenahealth.com/21787/brand/1/csg/1/fhir/r4
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1596067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596067200000",
"number": "1164031555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3028 DELIVERANCE DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809181675",
"telephone_number": "815-540-1688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4740 FLINTRIDGE DR STE 130",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809184273",
"telephone_number": "719-917-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "JUSTIN",
"credential": "LMT, HBS, CFSC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-30",
"last_updated": "2020-07-30",
"certification_date": "2020-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "MT.0022782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.