Active NPI
Kendra Amidon, LMT
- Massage Therapist
- La Vista, NE
National Provider Identifier
1487169116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 3340
- Practice address
- 12040 McDermott PLZ Ste 320
La Vista, NE 68128-2354 - Phone
- (402) 871-8469
- Fax
- (402) 597-2869
- NPI assigned
- Dec 4, 2017
- Last updated
- Oct 3, 2019
- 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 | 3340 | NE | Primary |
Addresses
Primary practice location
12040 McDermott PLZ Ste 320
La Vista, NE 68128-2354
Mailing address
8825 S 117TH St
La Vista, NE 68128-5567
Phone (402) 871-8469
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 |
|---|---|---|---|
| 3340 | NE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1570060800000",
"number": "1487169116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8825 S 117TH ST",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681285567",
"telephone_number": "402-871-8469",
"fax_number": "402-597-2869"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12040 MCDERMOTT PLZ STE 320",
"city": "LA VISTA",
"state": "NE",
"postal_code": "681282354",
"telephone_number": "402-871-8469",
"fax_number": "402-597-2869"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMIDON",
"first_name": "KENDRA",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-04",
"last_updated": "2019-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NE",
"license": "3340",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Vista, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.