Mary Amanda Petacchi, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

031147 Issued in NY

Practice address

257 Delaware Ave Ste 2
Delmar, NY 12054-1135

Phone

(845) 633-3866

NPI assigned

Feb 25, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1614211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1326632779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 DELAWARE AVE STE 2",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120541135",
            "telephone_number": "845-633-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 DELAWARE AVE STE 2",
            "city": "DELMAR",
            "state": "NY",
            "postal_code": "120541135",
            "telephone_number": "845-633-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETACCHI",
        "first_name": "MARY",
        "middle_name": "AMANDA",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-25",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "NY",
            "license": "031147",
            "primary": false
        },
        {
            "code": "225000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthotic Fitter",
            "state": "NY",
            "license": "031147",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "031147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.coppermoonbodywork.com",
            "affiliation": "N",
            "endpointDescription": "Business",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "257 Delaware Ave Ste 2",
            "city": "Delmar",
            "state": "NY",
            "country_code": "US",
            "postal_code": "120541135",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Www.coppermoonbodywork.com",
            "affiliation": "N",
            "endpointDescription": "Budiness",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "257 Delaware Ave Ste 2",
            "city": "Delmar",
            "state": "NY",
            "country_code": "US",
            "postal_code": "120541135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Barbara Farrell Pats, PH.D.
• John B. Pember, LCSW-R
• Cynthia Perlin, L.C.S.W.
• Alexis Weymann Perlmutter, M.D.
• Daniel Perry, BCBA
• Laura E Pica, M.D.
• Virginia A Plaisted, D.D.S.
• Patricia B. Politi, RPH
• Robin Love Pollitzer, LMSW
• Karin J. Potik, O.T.

• Massage Therapist in Delmar, NY
• Providers in Delmar, NY by specialty
• Massage Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 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.