Active NPI
Justin Randall Powell, LMT
- Massage Therapist
- Bellefontaine, OH
National Provider Identifier
1912613183
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17291
- Practice address
- 105 N Main St
Bellefontaine, OH 43311-2020 - Phone
- (937) 407-6293
- NPI assigned
- Jan 30, 2023
- Sex
- Male
- 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 | 17291 | OH | Primary |
Addresses
Primary practice location
105 N Main St
Bellefontaine, OH 43311-2020
Mailing address
105 N Main St
Bellefontaine, OH 43311-2020
Phone (937) 407-6293
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 |
|---|---|---|---|
| 17291 | OH | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Performance Holistic Health Center LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Massage Therapist
- Bellefontaine, OH
- NPI 1437681467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675036800000",
"number": "1912613183",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 N MAIN ST",
"city": "BELLEFONTAINE",
"state": "OH",
"postal_code": "433112020",
"telephone_number": "937-407-6293"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 N MAIN ST",
"city": "BELLEFONTAINE",
"state": "OH",
"postal_code": "433112020",
"telephone_number": "937-407-6293"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "JUSTIN",
"middle_name": "RANDALL",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-01-30",
"last_updated": "2023-01-30",
"certification_date": "2023-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OH",
"license": "17291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bellefontaine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.