Active NPI
Kelly K. Buck
- Massage Therapist
- Bainbridge, PA
National Provider Identifier
1346776192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 010616
- Practice address
- 221 Race St Apt 5
Bainbridge, PA 17502-9013 - Phone
- (717) 736-0656
- NPI assigned
- May 11, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 010616 | PA | Primary |
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
221 Race St Apt 5
Bainbridge, PA 17502-9013
Mailing address
737 Marietta Ave Apt 1
Lancaster, PA 17603-3437
Phone (717) 736-0656
Other practice location 1
2550 Interstate Dr Ste 201
Harrisburg, PA 17110-9614
Phone (717) 461-9018
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 |
|---|---|---|---|
| 010616 | PA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705363200000",
"number": "1346776192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "737 MARIETTA AVE APT 1",
"city": "LANCASTER",
"state": "PA",
"postal_code": "176033437",
"telephone_number": "717-736-0656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 RACE ST APT 5",
"city": "BAINBRIDGE",
"state": "PA",
"postal_code": "175029013",
"telephone_number": "717-736-0656"
}
],
"practiceLocations": [
{
"address_1": "2550 Interstate Dr Ste 201",
"address_purpose": "LOCATION",
"city": "Harrisburg",
"state": "PA",
"postal_code": "171109614",
"country_code": "US",
"telephone_number": "717-461-9018",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUCK",
"first_name": "KELLY",
"middle_name": "K.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-11",
"last_updated": "2024-01-16",
"certification_date": "2024-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "PA",
"license": "010616",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bainbridge, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 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.