Active NPI
Carla Young, LCMT
- Massage Therapist
- Cripple Creek, CO
National Provider Identifier
1164768164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 11831
- Practice address
- 151 E. Bennett Ave.
Cripple Creek, CO 80813 - Phone
- (719) 689-3502
- NPI assigned
- Dec 19, 2012
- 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 | 11831 | CO | Primary |
Addresses
Primary practice location
151 E. Bennett Ave.
Cripple Creek, CO 80813
Mailing address
PO Box 555
Victor, CO 80860-0555
Phone (719) 689-3502
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| #MT11831 | Other | CO | STATE |
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 |
|---|---|---|---|
| 11831 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355875200000",
"number": "1164768164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 555",
"city": "VICTOR",
"state": "CO",
"postal_code": "808600555",
"telephone_number": "719-689-3502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "151 E. BENNETT AVE.",
"city": "CRIPPLE CREEK",
"state": "CO",
"postal_code": "80813",
"telephone_number": "719-689-3502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "CARLA",
"credential": "LCMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-19",
"last_updated": "2012-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "11831",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "#MT11831",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cripple Creek, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.