Active NPI
Ibrahima S Sidibe, MASSAGE THERAPIST
- Massage Therapist
- Hattiesburg, MS
National Provider Identifier
1801102447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- LMT0403
- Practice address
- 6555 US 98 West
Suite a
Hattiesburg, MS 39402 - Phone
- (601) 261-0191
- Fax
- (601) 579-9782
- NPI assigned
- Aug 20, 2010
- Sex
- Male
- 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 | LMT0403 | MS | Primary |
Addresses
Primary practice location
6555 US 98 West
Suite a
Hattiesburg, MS 39402
Mailing address
6555 U S Highway 98
Suite a
Hattiesburg, MS 39402-8699
Phone (601) 261-0111
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 |
|---|---|---|---|
| LMT0403 | MS | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282262400000",
"number": "1801102447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6555 U S HIGHWAY 98",
"address_2": "SUITE A",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394028699",
"telephone_number": "601-261-0111",
"fax_number": "601-579-9782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6555 US 98 WEST",
"address_2": "SUITE A",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-261-0191",
"fax_number": "601-579-9782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDIBE",
"first_name": "IBRAHIMA",
"middle_name": "S",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-20",
"last_updated": "2010-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MS",
"license": "LMT0403",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.