Active NPI
Diana Reyes
- Massage Therapist
- Eagle, ID
National Provider Identifier
1578284592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-2679
- Practice address
- 82 E State St Ste D
Eagle, ID 83616-6048 - Phone
- (208) 739-7650
- NPI assigned
- Sep 7, 2022
- 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 | MAS-2679 | ID | Primary |
Addresses
Primary practice location
82 E State St Ste D
Eagle, ID 83616-6048
Mailing address
19881 Adirondack Way
Caldwell, ID 83605-8053
Phone (208) 739-7650
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 |
|---|---|---|---|
| MAS-2679 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1662508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1662508800000",
"number": "1578284592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19881 ADIRONDACK WAY",
"city": "CALDWELL",
"state": "ID",
"postal_code": "836058053",
"telephone_number": "208-739-7650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "82 E STATE ST STE D",
"city": "EAGLE",
"state": "ID",
"postal_code": "836166048",
"telephone_number": "208-739-7650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES",
"first_name": "DIANA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-07",
"last_updated": "2022-09-07",
"certification_date": "2022-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-2679",
"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 Sep 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.