Active NPI
Kelly Marie Bragger, LMT
- Massage Therapist
- Bay Shore, NY
National Provider Identifier
1750955951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 009649-1
- Practice address
- 375 E Main St Ste 7
Bay Shore, NY 11706-8418 - Phone
- (631) 343-4184
- Fax
- (631) 343-4168
- NPI assigned
- May 13, 2021
- 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 | 009649-1 | NY | Primary |
Addresses
Primary practice location
375 E Main St Ste 7
Bay Shore, NY 11706-8418
Mailing address
254 Seaman Ave Apt D4
New York, NY 10034-1285
Phone (917) 856-1438
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 |
|---|---|---|---|
| 009649-1 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620864000000",
"number": "1750955951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "254 SEAMAN AVE APT D4",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100341285",
"telephone_number": "917-856-1438"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 E MAIN ST STE 7",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068418",
"telephone_number": "631-343-4184",
"fax_number": "631-343-4168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAGGER",
"first_name": "KELLY",
"middle_name": "MARIE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-05-13",
"last_updated": "2021-05-13",
"certification_date": "2021-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "NY",
"license": "009649-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.