Active NPI
Lachetta Broadway
- Massage Therapist
- Kenosha, WI
National Provider Identifier
1982459053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12380-146
- Practice address
- 520 58TH St Ste 106
Kenosha, WI 53140-4114 - Phone
- (262) 551-1317
- NPI assigned
- Apr 22, 2024
- 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 | 12380-146 | WI | Primary |
Addresses
Primary practice location
520 58TH St Ste 106
Kenosha, WI 53140-4114
Mailing address
2401 2ND St
Kenosha, WI 53140-1052
Phone (262) 551-1317
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12380-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713744000000",
"number": "1982459053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 2ND ST",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531401052",
"telephone_number": "262-551-1317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "520 58TH ST STE 106",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531404114",
"telephone_number": "262-551-1317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROADWAY",
"first_name": "LACHETTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-04-22",
"last_updated": "2024-04-22",
"certification_date": "2024-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "12380-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
- Larry D Briand, MS, PT, ATC
- Bright From the Start
- Bright From the Start (Bright From The Start Intergenerational Center LLC)
- Bright From the Start Health Services LLC
- Bright Gal Investments LLC (Bright Way Med)
- Brookdale Senior Living Communities, Inc. (Wynwood of Kenosha)
- Brookdale Senior Living Communities, Inc. (Sterling House of Kenosha)
- Brookdale Senior Living Communities, Inc. (Clare Bridge of Kenosha)
- Karen M Brooker
- Brookside Care Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 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.