Active NPI
Kristen Marie Woudstra, LMT
- Massage Therapist
- Commerce TWP, MI
National Provider Identifier
1891264214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501009263
- Practice address
- 2685 Union Lake Rd
Commerce TWP, MI 48382-3560 - Phone
- (248) 366-6378
- NPI assigned
- Nov 14, 2018
- Sex
- Female
- Sole proprietor
- No
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 | 7501009263 | MI | Primary |
Addresses
Primary practice location
2685 Union Lake Rd
Commerce TWP, MI 48382-3560
Mailing address
2685 Union Lake Rd
Commerce TWP, MI 48382-3560
Phone (248) 366-6378
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 |
|---|---|---|---|
| 7501009263 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1542153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542153600000",
"number": "1891264214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2685 UNION LAKE RD",
"city": "COMMERCE TWP",
"state": "MI",
"postal_code": "483823560",
"telephone_number": "248-366-6378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2685 UNION LAKE RD",
"city": "COMMERCE TWP",
"state": "MI",
"postal_code": "483823560",
"telephone_number": "248-366-6378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOUDSTRA",
"first_name": "KRISTEN",
"middle_name": "MARIE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-11-14",
"last_updated": "2018-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501009263",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Commerce TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 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.