Active NPI
Derek A Hatch, MT
- Massage Therapist
- Bonners Ferry, ID
National Provider Identifier
1861108409
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-4154
- Practice address
- 222 Racoon LN
Bonners Ferry, ID 83805-6078 - Phone
- (208) 610-8136
- NPI assigned
- Jan 26, 2023
- 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 | MAS-4154 | ID | Primary |
Addresses
Primary practice location
222 Racoon LN
Bonners Ferry, ID 83805-6078
Mailing address
222 Racoon LN
Bonners Ferry, ID 83805-6078
Phone (208) 610-8136
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 |
|---|---|---|---|
| MAS-4154 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674691200000",
"number": "1861108409",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 RACOON LN",
"city": "BONNERS FERRY",
"state": "ID",
"postal_code": "838056078",
"telephone_number": "208-610-8136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 RACOON LN",
"city": "BONNERS FERRY",
"state": "ID",
"postal_code": "838056078",
"telephone_number": "208-610-8136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HATCH",
"first_name": "DEREK",
"middle_name": "A",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-26",
"last_updated": "2023-01-26",
"certification_date": "2023-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-4154",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonners Ferry, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.