Active NPI
Taylor McDonald
- Massage Therapist
- Boulder, CO
National Provider Identifier
1538875299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT.0018679
- Practice address
- 964 Lost Angel Rd
Boulder, CO 80302-9241 - Phone
- (903) 571-4617
- NPI assigned
- Jan 26, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | Q201038 | CO | |
| Massage Therapist | 225700000X | MT.0018679 | CO | Primary |
Addresses
Primary practice location
964 Lost Angel Rd
Boulder, CO 80302-9241
Mailing address
964 Lost Angel Rd
Boulder, CO 80302-9241
Phone (903) 571-4617
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 |
|---|---|---|---|
| Q201038 | CO | MD | Basic Emergency Medical Technician |
| MT.0018679 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1538875299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "964 LOST ANGEL RD",
"city": "BOULDER",
"state": "CO",
"postal_code": "803029241",
"telephone_number": "903-571-4617"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "964 LOST ANGEL RD",
"city": "BOULDER",
"state": "CO",
"postal_code": "803029241",
"telephone_number": "903-571-4617"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "TAYLOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-26",
"last_updated": "2023-01-26",
"certification_date": "2023-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "CO",
"license": "Q201038",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "MT.0018679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boulder, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.