Active NPI
Fawne Peterson, MT
- Massage Therapist
- Plymouth, MI
National Provider Identifier
1053785931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501002781
- Practice address
- 44191 Plymouth Oaks Blvd
Suite 400
Plymouth, MI 48170-6530 - Phone
- (734) 259-7103
- NPI assigned
- Nov 16, 2015
- Sex
- Female
- Sole proprietor
- No
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 | 7501002781 | MI | Primary |
Addresses
Primary practice location
44191 Plymouth Oaks Blvd
Suite 400
Plymouth, MI 48170-6530
Mailing address
44191 Plymouth Oaks Blvd
Suite 400
Plymouth, MI 48170-6530
Phone (734) 259-7103
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
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7501002781 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447632000000",
"number": "1053785931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "44191 PLYMOUTH OAKS BLVD",
"address_2": "SUITE 400",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706530",
"telephone_number": "734-259-7103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44191 PLYMOUTH OAKS BLVD",
"address_2": "SUITE 400",
"city": "PLYMOUTH",
"state": "MI",
"postal_code": "481706530",
"telephone_number": "734-259-7103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "FAWNE",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-16",
"last_updated": "2015-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501002781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.