Active NPI
Anneliese Wilson
- Massage Therapist
- Provo, UT
National Provider Identifier
1003049586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 6149567-4701
- Practice address
- 238 N University Ave Apt 16
Provo, UT 84601-2821 - Phone
- (801) 373-3484
- NPI assigned
- Aug 31, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 10378 | HI | |
| Massage Therapist | 225700000X | 6149567-4701 | UT | Primary |
Addresses
Primary practice location
238 N University Ave Apt 16
Provo, UT 84601-2821
Mailing address
710 W 800 N
Provo, UT 84601-1518
Phone (808) 206-2158
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 |
|---|---|---|---|
| 10378 | HI | MD | Specialist |
| 6149567-4701 | UT | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606003200000",
"number": "1003049586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "710 W 800 N",
"city": "PROVO",
"state": "UT",
"postal_code": "846011518",
"telephone_number": "808-206-2158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "238 N UNIVERSITY AVE APT 16",
"city": "PROVO",
"state": "UT",
"postal_code": "846012821",
"telephone_number": "801-373-3484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ANNELIESE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-31",
"last_updated": "2020-11-22",
"certification_date": "2020-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "HI",
"license": "10378",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "UT",
"license": "6149567-4701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.