Active NPI
McKellyn Miller
- Massage Therapist
- Sandpoint, ID
National Provider Identifier
1336734821
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-4214
- Practice address
- 1315 Highway 2 Ste 2
Sandpoint, ID 83864-2724 - Phone
- (208) 263-3211
- NPI assigned
- Mar 5, 2021
- Sex
- Female
- Sole proprietor
- No
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 | MAS-4214 | ID | Primary |
Addresses
Primary practice location
1315 Highway 2 Ste 2
Sandpoint, ID 83864-2724
Mailing address
320 Crooked Ear Dr
Sandpoint, ID 83864-9477
Phone (208) 597-3760
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 |
|---|---|---|---|
| MAS-4214 | ID | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ckam Rejuvenation Center LLC | Massage Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Massage Therapist
- Ponderay, ID
- NPI 1699309963
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614902400000",
"number": "1336734821",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "320 CROOKED EAR DR",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838649477",
"telephone_number": "208-597-3760"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1315 HIGHWAY 2 STE 2",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838642724",
"telephone_number": "208-263-3211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLER",
"first_name": "MCKELLYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-05",
"last_updated": "2021-03-05",
"certification_date": "2021-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-4214",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
- Daniel Jack Meulenberg, M.D.
- Michelle M. Anderson FNP, P.a.
- Denise Elizabeth Midstokke, CPM
- Mihin Chiropractic Clinic, PLLC
- Beth Elisha Miller, PA-C
- Tatum Marie Miller, LCPC
- Ginna Minervini, LCSW
- Monica Joy Mitzel, DHN, CH
- Mobile Laboratory Health Services
- Momentum Medical Massage and Personal Training, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.