Individual provider Active NPI

Harrison McCartney Tucker

  • Massage Therapist
  • Saint Louis Park, MN
National Provider Identifier
1902566466
Registry record updated Dec 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
00055236 Issued in MN
Practice address
6250 Excelsior Blvd Ste 103
Saint Louis Park, MN 55416-2735
Phone
(763) 614-0363
NPI assigned
Dec 26, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 26, 2021

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 00055236 MN Primary

Addresses

Primary practice location

6250 Excelsior Blvd Ste 103
Saint Louis Park, MN 55416-2735

Mailing address

6700 Richfield Pkwy Apt 326
Richfield, MN 55423-7523
Phone (715) 501-8930

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
00055236MNMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1640476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640476800000",
    "number": "1902566466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 RICHFIELD PKWY APT 326",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554237523",
            "telephone_number": "715-501-8930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6250 EXCELSIOR BLVD STE 103",
            "city": "SAINT LOUIS PARK",
            "state": "MN",
            "postal_code": "554162735",
            "telephone_number": "763-614-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "HARRISON",
        "middle_name": "MCCARTNEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-26",
        "last_updated": "2021-12-26",
        "certification_date": "2021-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MN",
            "license": "00055236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2021; 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.