NPIMap

Organization Active NPI

Idaho Sport Massage LLC

Doing business as Idaho Sport Massage

  • Massage Therapist
  • Pocatello, ID
National Provider Identifier
1932946332
Registry record updated Oct 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Legal business name
IDAHO SPORT MASSAGE LLC
Doing business as
Idaho Sport Massage
Practice address
675 Yellowstone Ave # 1
Pocatello, ID 83201-4511
Phone
(208) 478-1488
NPI assigned
Jul 11, 2024
Last updated
Oct 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mindy CervantesNPI 1013692276
Title
Owner
Phone
(435) 580-9461

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X Primary

Addresses

Primary practice location

675 Yellowstone Ave # 1
Pocatello, ID 83201-4511

Mailing address

4846 Hiram Ave
Chubbuck, ID 83202-3018
Phone (435) 580-9461

Other names 1

  • Idaho Sport Massage Doing business as

National Provider Directory

National Provider Directory

Locations

675 Yellowstone Ave
#1
Pocatello, ID 83201
Phone (208) 478-1488

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1932946332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4846 HIRAM AVE",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832023018",
            "telephone_number": "435-580-9461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 YELLOWSTONE AVE # 1",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014511",
            "telephone_number": "208-478-1488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SPORT MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "CERVANTES",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-580-9461"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Sport Massage",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Sport Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.