Active NPI
Agata M Foreman
- Massage Therapist
- Crystal Lake, IL
National Provider Identifier
1689292278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 02.021803
- Practice address
- 333 Commerce Dr Ste 175
Crystal Lake, IL 60014-3596 - Phone
- (224) 704-9218
- NPI assigned
- Jul 9, 2020
- Last updated
- Jul 9, 2020
- 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 | 02.021803 | IL | Primary |
Addresses
Primary practice location
333 Commerce Dr Ste 175
Crystal Lake, IL 60014-3596
Mailing address
6420 Lakewood Dr
Cary, IL 60013-1239
Phone (224) 704-9218
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 |
|---|---|---|---|
| 02.021803 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594252800000",
"number": "1689292278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6420 LAKEWOOD DR",
"city": "CARY",
"state": "IL",
"postal_code": "600131239",
"telephone_number": "224-704-9218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 COMMERCE DR STE 175",
"city": "CRYSTAL LAKE",
"state": "IL",
"postal_code": "600143596",
"telephone_number": "224-704-9218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOREMAN",
"first_name": "AGATA",
"middle_name": "M",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-09",
"last_updated": "2020-07-09",
"certification_date": "2020-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "02.021803",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crystal Lake, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.