NPIMap

Individual provider Active NPI

Keith Raymond Matherly, MASSAGE THERAPIST

  • Massage Therapist
  • Livonia, MI
National Provider Identifier
1871090191
Registry record updated Apr 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
7501000863 Issued in MI
Practice address
20000 Victor Pkwy Ste 100
Livonia, MI 48152-7027
Phone
(734) 953-1745
Fax
(734) 953-1743
NPI assigned
Apr 12, 2018
Last updated
Apr 12, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 7501000863 MI Primary

Addresses

Primary practice location

20000 Victor Pkwy Ste 100
Livonia, MI 48152-7027

Mailing address

20000 Victor Pkwy Ste 100
Livonia, MI 48152-7027
Phone (734) 953-1745

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
7501000863MIMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Recovery Project, LLC PastSince Oct 1, 2005 Accepting new patients
Fare to Freedom Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523491200000",
    "number": "1871090191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20000 VICTOR PKWY STE 100",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481527027",
            "telephone_number": "734-953-1745",
            "fax_number": "734-953-1743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20000 VICTOR PKWY STE 100",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481527027",
            "telephone_number": "734-953-1745",
            "fax_number": "734-953-1743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHERLY",
        "first_name": "KEITH",
        "middle_name": "RAYMOND",
        "credential": "MASSAGE THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-12",
        "last_updated": "2018-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501000863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livonia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2018; 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.