Active NPI
Cassandra Jean Lynn Kinnard, LMT
- Massage Therapist
- Pewaukee, WI
National Provider Identifier
1699469320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17049-146
- Practice address
- 325 Forest Grove Dr
Pewaukee, WI 53072-3894 - Phone
- (262) 563-3701
- NPI assigned
- Jun 6, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 17049-146 | WI | Primary |
Addresses
Primary practice location
325 Forest Grove Dr
Pewaukee, WI 53072-3894
Mailing address
325 Forest Grove Dr
Pewaukee, WI 53072-3894
Phone (262) 563-3701
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 |
|---|---|---|---|
| 17049-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707868800000",
"number": "1699469320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 FOREST GROVE DR",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530723894",
"telephone_number": "262-563-3701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 FOREST GROVE DR",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530723894",
"telephone_number": "262-563-3701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNARD",
"first_name": "CASSANDRA",
"middle_name": "JEAN LYNN",
"name_prefix": "Miss",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-06-06",
"last_updated": "2024-02-14",
"certification_date": "2024-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "17049-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.