Derrick A Powell, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227.022514 Issued in IL

Practice address

586 S Rosehall LN
Round Lake, IL 60073-4268

Phone

(847) 505-6944

NPI assigned

May 7, 2022

Last updated

May 7, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

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.

{
    "created_epoch": "1651881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651881600000",
    "number": "1487390084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "586 S ROSEHALL LN",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600734268",
            "telephone_number": "847-505-6944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "586 S ROSEHALL LN",
            "city": "ROUND LAKE",
            "state": "IL",
            "postal_code": "600734268",
            "telephone_number": "847-505-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POWELL",
        "first_name": "DERRICK",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-07",
        "last_updated": "2022-05-07",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227022514",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227.022514",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Round Lake, IL
• Providers in Round Lake, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.

Verify at the official NPI Registry.