Active NPI
Susan Dorinda Hetrick, LMT, MLD
- Massage Therapist
- Lockport, NY
National Provider Identifier
1730607052
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 030139-1
- Practice address
- 7397 Ridge Rd
Lockport, NY 14094-9458 - Phone
- (716) 622-6111
- Fax
- (716) 772-5322
- NPI assigned
- Sep 7, 2017
- 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 | 030139-1 | NY | Primary |
Addresses
Primary practice location
7397 Ridge Rd
Lockport, NY 14094-9458
Mailing address
7397 Ridge Rd
Lockport, NY 14094-9458
Phone (716) 622-6111
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 |
|---|---|---|---|
| 030139-1 | NY | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1504742400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623196800000",
"number": "1730607052",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7397 RIDGE RD",
"city": "LOCKPORT",
"state": "NY",
"postal_code": "140949458",
"telephone_number": "716-622-6111",
"fax_number": "716-772-5322"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7397 RIDGE RD",
"city": "LOCKPORT",
"state": "NY",
"postal_code": "140949458",
"telephone_number": "716-622-6111",
"fax_number": "716-772-5322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HETRICK",
"first_name": "SUSAN",
"middle_name": "DORINDA",
"credential": "LMT, MLD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-07",
"last_updated": "2021-06-09",
"certification_date": "2021-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "030139-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lockport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.