Healthcare Provider Details

I. General information

NPI: 1366359762
Provider Name (Legal Business Name): MASSAGE BY K
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10127 NORTHWESTERN AVE
CALEDONIA WI
53126-9206
US

IV. Provider business mailing address

3927 N GREEN BAY RD
CALEDONIA WI
53404-1415
US

V. Phone/Fax

Practice location:
  • Phone: 262-498-6206
  • Fax:
Mailing address:
  • Phone: 262-498-6206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAYLA ROGNSVOOG
Title or Position: OWNER/LEAD LMT
Credential: LMT
Phone: 262-498-6206