Active NPI
Bobby R Amagan, MASSAGE THERAPIST
- Massage Therapist
- Saint Paul, MN
National Provider Identifier
1558174516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 202400001821
- Practice address
- 245 Prior Ave N
Saint Paul, MN 55104-5163 - Phone
- (615) 524-0861
- NPI assigned
- Jan 31, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 202400001821 | MN | Primary |
Addresses
Primary practice location
245 Prior Ave N
Saint Paul, MN 55104-5163
Mailing address
3725 19TH Ave S
Minneapolis, MN 55407-2925
Phone (615) 524-0861
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 |
|---|---|---|---|
| 202400001821 | MN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738281600000",
"number": "1558174516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3725 19TH AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554072925",
"telephone_number": "615-524-0861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 PRIOR AVE N",
"city": "SAINT PAUL",
"state": "MN",
"postal_code": "551045163",
"telephone_number": "615-524-0861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AMAGAN",
"first_name": "BOBBY",
"middle_name": "R",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-31",
"last_updated": "2025-01-31",
"certification_date": "2025-01-31",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MN",
"license": "202400001821",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.