Active NPI
Tiffany L Powell, MT
- Massage Therapist
- Racine, WI
National Provider Identifier
1861079550
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 14889-146
- Practice address
- 3245 Packer Dr # 103
Racine, WI 53404-1151 - Phone
- (530) 414-8715
- NPI assigned
- Mar 27, 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 | 14889-146 | WI | Primary |
Addresses
Primary practice location
3245 Packer Dr # 103
Racine, WI 53404-1151
Mailing address
3245 Packer Dr # 103
Racine, WI 53404-1151
Phone (530) 414-8715
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14889-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616803200000",
"number": "1861079550",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 PACKER DR # 103",
"city": "RACINE",
"state": "WI",
"postal_code": "534041151",
"telephone_number": "530-414-8715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 PACKER DR # 103",
"city": "RACINE",
"state": "WI",
"postal_code": "534041151",
"telephone_number": "530-414-8715"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "TIFFANY",
"middle_name": "L",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-03-27",
"last_updated": "2021-03-27",
"certification_date": "2021-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "14889-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Racine, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.