Tina Cecilie Wambeke

Primary specialty

MechanotherapistTaxonomy code 172M00000X

License

1232 Issued in MT

Practice address

119 S. Main St.
Restoration Massage Therapy, LLC
Three Forks, MT 59752

Phone

(406) 285-4263

Fax

(406) 285-4628

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

Yes

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, last updated by the provider on Jan 19, 2012.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1366713562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 S. MAIN ST.",
            "address_2": "P.O. BOX 863",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "597520863",
            "telephone_number": "406-285-4263",
            "fax_number": "406-285-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 S. MAIN ST.",
            "address_2": "RESTORATION MASSAGE THERAPY, LLC",
            "city": "THREE FORKS",
            "state": "MT",
            "postal_code": "59752",
            "telephone_number": "406-285-4263",
            "fax_number": "406-285-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAMBEKE",
        "first_name": "TINA",
        "middle_name": "CECILIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": "MT",
            "license": "1232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA BOARD OF MASSAGE THERAPY",
            "identifier": "LICENSE 1232",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF MEDICAL EXAMINERS, EMERGENCY MEDICAL TECHNICIAN- BASIC",
            "identifier": "LICENSE 7956",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Three Forks School District #J24
• Three Forks School District #J24
• Three Rivers Clinic LLC
• Tobacco Root Anesthesiology, LLC
• Mark E Vandolah, CRNA
• Shannon Rose Zuelke, PTA

• All providers in Three Forks, MT
• Mechanotherapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; 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.