Active NPI
Tile Pan
- Massage Therapist
- Rapid City, SD
National Provider Identifier
1619559739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT11775
- Practice address
- 2415 Mount Rushmore Rd Ste B
Rapid City, SD 57701-5102 - Phone
- (605) 545-8543
- NPI assigned
- Apr 27, 2021
- 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 | MT11775 | SD | Primary |
Addresses
Primary practice location
2415 Mount Rushmore Rd Ste B
Rapid City, SD 57701-5102
Mailing address
2415 Mount Rushmore Rd Ste B
Rapid City, SD 57701-5102
Phone (605) 545-8543
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 |
|---|---|---|---|
| MT11775 | SD | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Zeitaku Foot Town LLC | Single Specialty | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619481600000",
"number": "1619559739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2415 MOUNT RUSHMORE RD STE B",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577015102",
"telephone_number": "605-545-8543"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 MOUNT RUSHMORE RD STE B",
"city": "RAPID CITY",
"state": "SD",
"postal_code": "577015102",
"telephone_number": "605-545-8543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAN",
"first_name": "TILE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-27",
"last_updated": "2021-04-27",
"certification_date": "2021-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "SD",
"license": "MT11775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rapid City, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.