Active NPI
Kelly Gray, LMT
- Massage Therapist
- Hampton, IL
National Provider Identifier
1891043675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.011622
- Practice address
- 510 State Ave Ste 3
Hampton, IL 61256-9690 - Phone
- (309) 751-9790
- NPI assigned
- Aug 27, 2012
- Last updated
- Aug 27, 2012
- 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 | 227.011622 | IL | Primary |
Addresses
Primary practice location
510 State Ave Ste 3
Hampton, IL 61256-9690
Mailing address
29 Shady BCH
Geneseo, IL 61254-9106
Phone (309) 737-5029
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 |
|---|---|---|---|
| 227.011622 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1891043675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 SHADY BCH",
"city": "GENESEO",
"state": "IL",
"postal_code": "612549106",
"telephone_number": "309-737-5029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 STATE AVE STE 3",
"city": "HAMPTON",
"state": "IL",
"postal_code": "612569690",
"telephone_number": "309-751-9790"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "KELLY",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-27",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.011622",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hampton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.