Active NPI
Moon Leaf Derosier, CMT
- Massage Therapist
- Atascadero, CA
National Provider Identifier
1043663438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10405
- Practice address
- 5960B West Mall
Atascadero, CA 93422-4232 - Phone
- (415) 706-6397
- NPI assigned
- Jul 20, 2016
- Last updated
- Jul 20, 2016
- 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 | 10405 | CA | Primary |
Addresses
Primary practice location
5960B West Mall
Atascadero, CA 93422-4232
Mailing address
PO Box 4273
Paso Robles, CA 93447-4273
Phone (415) 706-6397
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 |
|---|---|---|---|
| 10405 | CA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468972800000",
"number": "1043663438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4273",
"city": "PASO ROBLES",
"state": "CA",
"postal_code": "934474273",
"telephone_number": "415-706-6397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5960B WEST MALL",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934224232",
"telephone_number": "415-706-6397"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSIER",
"first_name": "MOON LEAF",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-07-20",
"last_updated": "2016-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "10405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
- Joevilyn Trance Delos Trino, NP
- Aline Galilee Deluca
- Heather Demosthenes, M.S., CCC-SLP
- Department of State Hospitals (Department of State Hospitals-Atascadero)
- Melissa Depoorter, PHD, LMFT
- Elisabeth Deswart, MS RD
- Deirdre J Devlin, LCSW
- Mary Catherine Espiritu Diaz, FNP-C
- Miguel Karlo Lacson Diaz, FNP-C
- Richard H Diel, RPT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.