Active NPI
Kenneth Rodriguez, LMT
- Massage Therapist
- Saint Peters, MO
National Provider Identifier
1265248595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2001032303
- Practice address
- 3899 Mid Rivers Mall Dr
Saint Peters, MO 63376-2870 - Phone
- (314) 575-1212
- NPI assigned
- Dec 11, 2024
- 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 | 2001032303 | MO | Primary |
Addresses
Primary practice location
3899 Mid Rivers Mall Dr
Saint Peters, MO 63376-2870
Mailing address
PO Box 510096
Saint Louis, MO 63151-0096
Phone (314) 575-1212
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 |
|---|---|---|---|
| 2001032303 | MO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1733875200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733875200000",
"number": "1265248595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 510096",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631510096",
"telephone_number": "314-575-1212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3899 MID RIVERS MALL DR",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633762870",
"telephone_number": "314-575-1212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "KENNETH",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-12-11",
"last_updated": "2024-12-11",
"certification_date": "2024-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2001032303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.