Active NPI
Holly Lodge, MT
- Massage Therapist
- Dearborn, MI
National Provider Identifier
1962670281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 3413 Edgewood St
Dearborn, MI 48124-4167 - Phone
- (313) 930-9139
- NPI assigned
- Feb 20, 2008
- 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 | Primary |
Addresses
Primary practice location
3413 Edgewood St
Dearborn, MI 48124-4167
Mailing address
3413 Edgewood St
Dearborn, MI 48124-4167
Phone (313) 930-9139
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1203465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1203465600000",
"number": "1962670281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3413 EDGEWOOD ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244167",
"telephone_number": "313-930-9139"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3413 EDGEWOOD ST",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481244167",
"telephone_number": "313-930-9139"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODGE",
"first_name": "HOLLY",
"name_prefix": "Ms.",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-02-20",
"last_updated": "2008-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.