Active NPI
Nevin Grossnickle, CERTIFIED MASSAGE TH
- Massage Therapist
- Wausau, WI
National Provider Identifier
1467861328
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10444-146
- Practice address
- 319 4TH Street, LL
Wausau, WI 54403 - Phone
- (715) 693-6095
- NPI assigned
- Aug 5, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 | 10444-146 | WI | Primary |
Addresses
Primary practice location
319 4TH Street, LL
Wausau, WI 54403
Mailing address
981 Wambold Dr
Mosinee, WI 54455-9583
Phone (715) 693-6095
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 |
|---|---|---|---|
| 10444-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407369600000",
"number": "1467861328",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "981 WAMBOLD DR",
"city": "MOSINEE",
"state": "WI",
"postal_code": "544559583",
"telephone_number": "715-693-6095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "319 4TH STREET, LL",
"city": "WAUSAU",
"state": "WI",
"postal_code": "54403",
"telephone_number": "715-693-6095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSSNICKLE",
"first_name": "NEVIN",
"credential": "CERTIFIED MASSAGE TH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-05",
"last_updated": "2014-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "10444-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.