Active NPI
Tyler James Pincock, BS, LMT
- Massage Therapist
- Idaho Falls, ID
National Provider Identifier
1992294565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MAS-2570
- Practice address
- 1110 S Boulevard
Idaho Falls, ID 83402-4033 - Phone
- (208) 270-3358
- NPI assigned
- May 9, 2018
- Sex
- Male
- 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 | MAS-2570 | ID | Primary |
Addresses
Primary practice location
1110 S Boulevard
Idaho Falls, ID 83402-4033
Mailing address
1125 Hemlock St
Idaho Falls, ID 83401-2914
Phone (208) 557-9365
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
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MAS-2570 | ID | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525824000000",
"number": "1992294565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 HEMLOCK ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834012914",
"telephone_number": "208-557-9365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 S BOULEVARD",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834024033",
"telephone_number": "208-270-3358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PINCOCK",
"first_name": "TYLER",
"middle_name": "JAMES",
"credential": "BS, LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-09",
"last_updated": "2018-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ID",
"license": "MAS-2570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.