Individual provider Active NPI

Michelle Roudebush, MASSAGE THERAPIST

  • Massage Therapist
  • Marion, IN
National Provider Identifier
1720550619
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
21505618 Issued in IN
Practice address
518 S Baldwin Ave
Marion, IN 46953-1373
Phone
(260) 377-9519
NPI assigned
Dec 18, 2018
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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 21505618 IN Primary

Addresses

Primary practice location

518 S Baldwin Ave
Marion, IN 46953-1373

Mailing address

111 E Grant St
La Fontaine, IN 46940-9238
Phone (260) 377-9519

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Undefined Non-Physician Type (Specify)
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

111 E Grant St
La Fontaine, IN 46940-9238

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21505618INMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Heart and Soul Therapeutic Massage Massage Therapist CurrentSince May 7, 2024 Accepting new patients

Locations

518 S Baldwin Ave
Marion, IN 46953
Phone (260) 377-9519

Organizations & group practices 1

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": "1545091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1720550619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E GRANT ST",
            "city": "LA FONTAINE",
            "state": "IN",
            "postal_code": "469409238",
            "telephone_number": "260-377-9519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 S BALDWIN AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469531373",
            "telephone_number": "260-377-9519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUDEBUSH",
        "first_name": "MICHELLE",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-12-18",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "21505618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.