Active NPI
Kirsten Dayle Bodnarchuk, LMT
- Massage Therapist
- Annapolis, MD
National Provider Identifier
1619228285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- M04429
- Practice address
- 31 Old Solomons Island Rd
Annapolis, MD 21401-3897 - Phone
- (410) 990-0111
- NPI assigned
- Sep 24, 2012
- 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 | M04429 | MD | Primary |
Addresses
Primary practice location
31 Old Solomons Island Rd
Annapolis, MD 21401-3897
Mailing address
91 Barrensdale Dr
Severna Park, MD 21146-4814
Phone (443) 618-3181
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 |
|---|---|---|---|
| M04429 | MD | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348444800000",
"number": "1619228285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "91 BARRENSDALE DR",
"city": "SEVERNA PARK",
"state": "MD",
"postal_code": "211464814",
"telephone_number": "443-618-3181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "31 OLD SOLOMONS ISLAND RD",
"city": "ANNAPOLIS",
"state": "MD",
"postal_code": "214013897",
"telephone_number": "410-990-0111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODNARCHUK",
"first_name": "KIRSTEN",
"middle_name": "DAYLE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-24",
"last_updated": "2012-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MD",
"license": "M04429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Annapolis, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.