Individual provider Active NPI

Yvonne Amorette Henrikson, LMT

  • Massage Therapist
  • South Lyon, MI
National Provider Identifier
1750988002
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
7501002026 Issued in MI
Practice address
22180 Pontiac TRL Ste E
South Lyon, MI 48178-9097
Phone
(248) 446-0155
Fax
(248) 446-0177
NPI assigned
Oct 8, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X 7501002026 MI Primary

Addresses

Primary practice location

22180 Pontiac TRL Ste E
South Lyon, MI 48178-9097

Mailing address

22180 Pontiac TRL Ste E
South Lyon, MI 48178-9097
Phone (248) 446-0155

Other identifiers 1

IdentifierTypeStateIssuer
7501002026OtherMILMT LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address therapist@brostrompt.com Direct

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

LicenseStateTypeSpecialty
7501002026MIMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Spine and Extremity Institute of South Lyon, L.L.C. Single Specialty CurrentSince Oct 11, 2020 Accepting new patients
Plymouth Physical Therapy Specialists Limited Partnership PastSince Oct 11, 2020 Accepting new patients

Locations

22180 Pontiac Trl
Ste E
South Lyon, MI 48178
Phone (248) 446-0155

Organizations & group practices 2

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": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1750988002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22180 PONTIAC TRL STE E",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789097",
            "telephone_number": "248-446-0155",
            "fax_number": "248-446-0177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22180 PONTIAC TRL STE E",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789097",
            "telephone_number": "248-446-0155",
            "fax_number": "248-446-0177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRIKSON",
        "first_name": "YVONNE",
        "middle_name": "AMORETTE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501002026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMT LICENSE",
            "identifier": "7501002026",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "therapist@brostrompt.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fax",
            "address_1": "22180 Pontiac Trl Ste E",
            "city": "South Lyon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "481789097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Lyon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.