Active NPI
Anna Boge, L.M.T., M.M.P.
- Massage Therapist
- North Liberty, IA
National Provider Identifier
1720462187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 006773
- Practice address
- 1395 Jordan St
North Liberty, IA 52317-4759 - Phone
- (319) 774-3811
- NPI assigned
- Jul 16, 2015
- Last updated
- Jul 16, 2015
- 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 | 006773 | IA | Primary |
Addresses
Primary practice location
1395 Jordan St
North Liberty, IA 52317-4759
Mailing address
1016 130TH St
West Liberty, IA 52776-9121
Phone (563) 564-0720
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 |
|---|---|---|---|
| 006773 | IA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437004800000",
"number": "1720462187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 130TH ST",
"city": "WEST LIBERTY",
"state": "IA",
"postal_code": "527769121",
"telephone_number": "563-564-0720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1395 JORDAN ST",
"city": "NORTH LIBERTY",
"state": "IA",
"postal_code": "523174759",
"telephone_number": "319-774-3811"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGE",
"first_name": "ANNA",
"credential": "L.M.T., M.M.P.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-16",
"last_updated": "2015-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IA",
"license": "006773",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Liberty, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.