Active NPI
Ryan Samuel Pack
- Massage Therapist
- Longmont, CO
National Provider Identifier
1588908859
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2746
- Practice address
- 500 9TH Ave
Suite 5
Longmont, CO 80501-4598 - Phone
- (303) 590-4969
- NPI assigned
- Nov 26, 2012
- Sex
- Male
- 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 | 2746 | CO | Primary |
Addresses
Primary practice location
500 9TH Ave
Suite 5
Longmont, CO 80501-4598
Mailing address
107 Caribou PL
Longmont, CO 80504-1206
Phone (303) 590-4969
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 |
|---|---|---|---|
| 2746 | CO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1353888000000",
"number": "1588908859",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 CARIBOU PL",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805041206",
"telephone_number": "303-590-4969"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 9TH AVE",
"address_2": "SUITE 5",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805014598",
"telephone_number": "303-590-4969"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PACK",
"first_name": "RYAN",
"middle_name": "SAMUEL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-11-26",
"last_updated": "2012-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CO",
"license": "2746",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.