Active NPI
Brenda G Smith, LMT
- Massage Therapist
- Eagle, ID
National Provider Identifier
1487168142
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MASG-2220
- Practice address
- 1545 E Iron Eagle Dr Ste 103
Eagle, ID 83616-7079 - Phone
- (208) 649-4405
- NPI assigned
- Nov 16, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MASG-2220 | ID | Primary |
Addresses
Primary practice location
1545 E Iron Eagle Dr Ste 103
Eagle, ID 83616-7079
Mailing address
10633 N Sagecrest PL
Boise, ID 83714-9562
Phone (404) 441-1146
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 |
|---|---|---|---|
| MASG-2220 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510790400000",
"number": "1487168142",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10633 N SAGECREST PL",
"city": "BOISE",
"state": "ID",
"postal_code": "837149562",
"telephone_number": "404-441-1146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1545 E IRON EAGLE DR STE 103",
"city": "EAGLE",
"state": "ID",
"postal_code": "836167079",
"telephone_number": "208-649-4405"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "BRENDA",
"middle_name": "G",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-11-16",
"last_updated": "2017-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MASG-2220",
"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 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.