Active NPI
David Leroy Crettol, L.M.T.
- Massage Therapist
- Coeur d'Alene, ID
National Provider Identifier
1841609856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-3256
- Practice address
- 2005 N Ironwood Pkwy Ste 216
Coeur D Alene, ID 83814-2647 - Phone
- (208) 659-6459
- NPI assigned
- Aug 5, 2014
- Last updated
- Apr 22, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 7258 | NM | |
| Massage Therapist | 225700000X | MAS-3256 | ID | Primary |
Addresses
Primary practice location
2005 N Ironwood Pkwy Ste 216
Coeur D Alene, ID 83814-2647
Mailing address
212 W Ironwood Dr Ste D
Coeur D Alene, ID 83814-1403
Phone (208) 659-6459
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 |
|---|---|---|---|
| MAS-3256 | ID | MD | Massage Therapist |
| 7258 | NM | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587513600000",
"number": "1841609856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "212 W IRONWOOD DR STE D",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838141403",
"telephone_number": "208-659-6459"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 N IRONWOOD PKWY STE 216",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142647",
"telephone_number": "208-659-6459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRETTOL",
"first_name": "DAVID",
"middle_name": "LEROY",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-08-05",
"last_updated": "2020-04-22",
"certification_date": "2020-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NM",
"license": "7258",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-3256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur d'Alene, ID
- Crescent Moon Counseling, LLC
- Tyler Joel Cress, PHARMD
- Crest Home Health and Hospice, LLC (Crest Home Health and Hospice)
- Crest Home Health and Hospice, LLC
- Crest Home Health and Hospice, LLC
- Richard V Cripe, PHYD
- Jonathan David Crisman, HIS
- Krista L Criswell, DIETITIAN
- Karyn L Crone, LMSW
- Albert Allen Crook, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.