Individual provider Active NPI

Sherrie L Rudolph, LMT

  • Massage Therapist
  • Medina, OH
National Provider Identifier
1689943565
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
33.013588 Issued in OH
Practice address
155 Northland Dr
Medina, OH 44256-1534
Phone
(330) 723-1441
Fax
(330) 723-1881
NPI assigned
Dec 21, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 33.013588 OH Primary

Addresses

Primary practice location

155 Northland Dr
Medina, OH 44256-1534

Mailing address

5087 Silver Maple LN
Medina, OH 44256-8377
Phone (330) 819-5725

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

LicenseStateTypeSpecialty
33.013588OHMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Maximum Potential Chiropractic Westlake, LLC PastSince Aug 6, 2019 Accepting new patients
Maximum Potential Chiropractic, Inc. PastSince Jul 1, 2005 Accepting new patients

Organizations & group practices 2

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": "1324425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1689943565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5087 SILVER MAPLE LN",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568377",
            "telephone_number": "330-819-5725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 NORTHLAND DR",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561534",
            "telephone_number": "330-723-1441",
            "fax_number": "330-723-1881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "SHERRIE",
        "middle_name": "L",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-21",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OH",
            "license": "33.013588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.