Active NPI
Matthew Demers, LMT
- Massage Therapist
- Eagle, ID
National Provider Identifier
1356987390
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-3262
- Practice address
- 1045 S Ancona Ave Ste 140
Eagle, ID 83616-6374 - Phone
- (208) 352-3883
- NPI assigned
- Nov 25, 2019
- Sex
- Male
- 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-3262 | ID | Primary |
Addresses
Primary practice location
1045 S Ancona Ave Ste 140
Eagle, ID 83616-6374
Mailing address
172 N Sevenoaks Ave
Eagle, ID 83616-7308
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-3262 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574640000000",
"number": "1356987390",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "172 N SEVENOAKS AVE",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 S ANCONA AVE STE 140",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166374",
"telephone_number": "208-352-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMERS",
"first_name": "MATTHEW",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-25",
"last_updated": "2019-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-3262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.