Active NPI
Merlyn Bonilla, LMT
- Massage Therapist
- Glastonbury, CT
National Provider Identifier
1376265264
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 11012
- Practice address
- 730 Hebron Ave Ste 3
Glastonbury, CT 06033-5016 - Phone
- (860) 410-4490
- Fax
- (860) 410-4492
- NPI assigned
- Sep 16, 2022
- 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 | 11012 | CT | Primary |
Addresses
Primary practice location
730 Hebron Ave Ste 3
Glastonbury, CT 06033-5016
Mailing address
730 Hebron Ave Ste 3
Glastonbury, CT 06033-5016
Phone (860) 410-4490
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663286400000",
"number": "1376265264",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "730 HEBRON AVE STE 3",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060335016",
"telephone_number": "860-410-4490",
"fax_number": "860-410-4492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 HEBRON AVE STE 3",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060335016",
"telephone_number": "860-410-4490",
"fax_number": "860-410-4492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONILLA",
"first_name": "MERLYN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-16",
"last_updated": "2022-09-16",
"certification_date": "2022-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CT",
"license": "11012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.