Active NPI
Andrea Gardener
- Massage Therapist
- Woodland Park, CO
National Provider Identifier
1619695392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0025121
- Practice address
- 216 W Midland Ave
Woodland Park, CO 80863-3206 - Phone
- (719) 687-2599
- NPI assigned
- Aug 18, 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 | 0025121 | CO | Primary |
Addresses
Primary practice location
216 W Midland Ave
Woodland Park, CO 80863-3206
Mailing address
PO Box 5796
Woodland Park, CO 80866-5796
Phone (719) 687-2599
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 |
|---|---|---|---|
| 0025121 | CO | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thunder Mountain Holdings, LLC | Single Specialty | Past | 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": "1660780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660780800000",
"number": "1619695392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5796",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808665796",
"telephone_number": "719-687-2599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "216 W MIDLAND AVE",
"city": "WOODLAND PARK",
"state": "CO",
"postal_code": "808633206",
"telephone_number": "719-687-2599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARDENER",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-08-18",
"last_updated": "2022-08-18",
"certification_date": "2022-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CO",
"license": "0025121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Woodland Park, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.