Active NPI
Angelina Black, LMT
- Massage Therapist
- South Salt Lake, UT
National Provider Identifier
1629640669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 8695543-4701
- Practice address
- 3151 S 400 E Apt 4
South Salt Lake, UT 84115-4076 - Phone
- (801) 897-2528
- NPI assigned
- Jul 9, 2021
- 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 | 8695543-4701 | UT | Primary |
Addresses
Primary practice location
3151 S 400 E Apt 4
South Salt Lake, UT 84115-4076
Mailing address
3151 S 400 E Apt 4
South Salt Lake, UT 84115-4076
Phone (801) 897-2528
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 |
|---|---|---|---|
| 8695543-4701 | UT | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625788800000",
"number": "1629640669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3151 S 400 E APT 4",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841154076",
"telephone_number": "801-897-2528"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3151 S 400 E APT 4",
"city": "SOUTH SALT LAKE",
"state": "UT",
"postal_code": "841154076",
"telephone_number": "801-897-2528"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "ANGELINA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-09",
"last_updated": "2021-07-09",
"certification_date": "2021-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "UT",
"license": "8695543-4701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.