Bryon Keith Stolle II, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MAS-3858 Issued in ID

Practice address

781 N Shadowridge Ave
Eagle, ID 83616-5674

Phone

(208) 573-0842

NPI assigned

Nov 30, 2022

Last updated

Nov 30, 2022By the provider in NPPES

Sex

Male

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

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

{
    "created_epoch": "1669766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669766400000",
    "number": "1912617960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 N SHADOWRIDGE AVE",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165674",
            "telephone_number": "208-573-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 N SHADOWRIDGE AVE",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165674",
            "telephone_number": "208-573-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLLE",
        "first_name": "BRYON",
        "middle_name": "KEITH",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-11-30",
        "last_updated": "2022-11-30",
        "certification_date": "2022-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ID",
            "license": "MAS-3858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Eagle, ID
• Providers in Eagle, ID by specialty
• Massage Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.