Carrie Elaine Boucher, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

0019006762 Issued in VA

Practice address

210 Professional Park Dr SE Ste 10
Blacksburg, VA 24060-6649

Phone

(540) 605-8751

Fax

(540) 750-4062

NPI assigned

Apr 21, 2011

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Body Balance Therapeutic Massage

  • Massage Therapist
  • Blacksburg, VA
  • NPI 1083950406
  NPD Authorized official

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

{
    "created_epoch": "1303344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630886400000",
    "number": "1174814487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 HAYMAKER ST",
            "city": "CHRISTIANSBURG",
            "state": "VA",
            "postal_code": "240733115",
            "telephone_number": "540-449-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 PROFESSIONAL PARK DR SE STE 10",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240606649",
            "telephone_number": "540-605-8751",
            "fax_number": "540-750-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "CARRIE",
        "middle_name": "ELAINE",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-04-21",
        "last_updated": "2021-09-06",
        "certification_date": "2021-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "VA",
            "license": "0019006762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bolden Therapy & Wellness, LLC (Shameka Bolden)
• Antonio Markeith Bolden, LPC
• Stacey Bolt, LPC
• Hanna Boothe
• Travis Bostic, LPC
• Richard Prentice Boyle III, DDS
• Rebecca J Brace, LCSW
• Jared Brackenrich, D.O.
• Elizabeth Hope Bradbury, LCSW
• Jennifer Renae Bradley, PHARMD

• Massage Therapist in Blacksburg, VA
• Providers in Blacksburg, VA by specialty
• Massage Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; 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.