Active NPI
Edward Montgomnery Jr., MASSOTHERAPIST
- Massage Therapist
- Canfield, OH
National Provider Identifier
1649666595
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 019086
- Practice address
- 4259 Boardman Canfield Rd
Canfield, OH 44406-8064 - Phone
- (330) 702-1872
- NPI assigned
- Apr 7, 2015
- 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 | 019086 | OH | Primary |
Addresses
Primary practice location
4259 Boardman Canfield Rd
Canfield, OH 44406-8064
Mailing address
4722 Warren Sharon Rd
Vienna, OH 44473-9637
Phone (330) 503-8605
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 |
|---|---|---|---|
| 019086 | OH | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428364800000",
"number": "1649666595",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4722 WARREN SHARON RD",
"city": "VIENNA",
"state": "OH",
"postal_code": "444739637",
"telephone_number": "330-503-8605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4259 BOARDMAN CANFIELD RD",
"city": "CANFIELD",
"state": "OH",
"postal_code": "444068064",
"telephone_number": "330-702-1872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMNERY",
"first_name": "EDWARD",
"name_suffix": "Jr.",
"credential": "MASSOTHERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-04-07",
"last_updated": "2015-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OH",
"license": "019086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.