Active NPI
Robert T Detamble, LMT
- Massage Therapist
- Williamsville, NY
National Provider Identifier
1710285200
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 020131
- Practice address
- 6245 Sheridan Dr
Suite116
Williamsville, NY 14221-4834 - Phone
- (716) 573-6553
- NPI assigned
- Mar 7, 2011
- 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 | 020131 | NY | Primary |
Addresses
Primary practice location
6245 Sheridan Dr
Suite116
Williamsville, NY 14221-4834
Mailing address
6245 Sheridan Dr
Suite116
Williamsville, NY 14221-4834
Phone (716) 573-6553
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 |
|---|---|---|---|
| 020131 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299456000000",
"number": "1710285200",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6245 SHERIDAN DR",
"address_2": "SUITE116",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142214834",
"telephone_number": "716-573-6553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6245 SHERIDAN DR",
"address_2": "SUITE116",
"city": "WILLIAMSVILLE",
"state": "NY",
"postal_code": "142214834",
"telephone_number": "716-573-6553"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETAMBLE",
"first_name": "ROBERT",
"middle_name": "T",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-07",
"last_updated": "2011-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "020131",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.