Active NPI
Beth Ann Denniston, MT
- Massage Therapist
- Bloomington, IN
National Provider Identifier
1962065813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT21405186
- Practice address
- 341 S Lincoln St Apt 4
Bloomington, IN 47401-2705 - Phone
- (812) 369-9910
- NPI assigned
- Apr 16, 2019
- Sex
- Female
- 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 | MT21405186 | IN | Primary |
Addresses
Primary practice location
341 S Lincoln St Apt 4
Bloomington, IN 47401-2705
Mailing address
4123 W Sierra Dr
Bloomington, IN 47403-5138
Phone (812) 369-9910
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MT21405186 | Other | IN | MASSAGE THERAPY |
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT21405186 | IN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1555372800000",
"number": "1962065813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4123 W SIERRA DR",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474035138",
"telephone_number": "812-369-9910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "341 S LINCOLN ST APT 4",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474012705",
"telephone_number": "812-369-9910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DENNISTON",
"first_name": "BETH",
"middle_name": "ANN",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-04-16",
"last_updated": "2019-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT21405186",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE THERAPY",
"identifier": "MT21405186",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.