Fanta Kysone Sychampanakhone, CMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

768918 Issued in MN

Practice address

234 Pine Cone Rd Ste B
Sartell, MN 56377-2504

Phone

(320) 253-5255

Fax

(320) 253-5260

NPI assigned

Oct 10, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sailer Family Chiropractic P.a.

  • Chiropractor
  • Sartell, MN
  • NPI 1255562435
  NPD
• Relax and Recover Massage LLC

  • Massage Therapist
  • Sartell, MN
  • NPI 1922941905
  NPD (past)

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1881319085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 PINE CONE RD STE B",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772504",
            "telephone_number": "320-253-5255",
            "fax_number": "320-253-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 PINE CONE RD STE B",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563772504",
            "telephone_number": "320-253-5255",
            "fax_number": "320-253-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYCHAMPANAKHONE",
        "first_name": "FANTA",
        "middle_name": "KYSONE",
        "credential": "CMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MN",
            "license": "768918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Stone
• Zoraida S Streit
• Dean Alan Stulz, PA
• Michael M Svensson, D.C.
• Noelle Evelyn Swanson
• Madison Tadych
• Olivia Ann Tadych
• Tandem Orthotics and Prosthetics, Inc.
• Joshua N Tapio
• Hannah Tatge

• Massage Therapist in Sartell, MN
• Providers in Sartell, MN by specialty
• Massage Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; 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.