NPIMap

Organization Active NPI

Kneaded Medical Massage LLC

  • Massage Therapist
  • Beckley, WV
National Provider Identifier
1972039717
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
2014-3267 Issued in WV
Legal business name
KNEADED MEDICAL MASSAGE LLC
Practice address
167 Dry Hill Rd
Beckley, WV 25801-2603
Phone
(304) 256-1111
Fax
(304) 256-1113
NPI assigned
May 11, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

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

Authorized official

Name
Jessica Ashley Coburn, LMTNPI 1477955318
Title
Co-Owner
Phone
(304) 952-1692

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X 2014-3267 WV Primary

Addresses

Primary practice location

167 Dry Hill Rd
Beckley, WV 25801-2603

Mailing address

PO Box 586
Beckley, WV 25802-0586
Phone (304) 256-1111

Other names 1

  • Medical Massage Doing business as

National Provider Directory

National Provider Directory

Locations

167 Dry Hill Rd
Beckley, WV 25801
Phone (304) 256-1111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1972039717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 586",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258020586",
            "telephone_number": "304-256-1111",
            "fax_number": "304-256-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 DRY HILL RD",
            "city": "BECKLEY",
            "state": "WV",
            "postal_code": "258012603",
            "telephone_number": "304-256-1111",
            "fax_number": "304-256-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNEADED MEDICAL MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-05-11",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "COBURN",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ASHLEY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "304-952-1692",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WV",
            "license": "2014-3267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beckley, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; 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.