Active NPI
Lauren Reese, CMT
- Massage Therapist
- Fort Wayne, IN
National Provider Identifier
1083081400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT21304814
- Practice address
- 5111 N Bend Dr
Fort Wayne, IN 46804-1753 - Phone
- (260) 436-8807
- NPI assigned
- Sep 2, 2015
- 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 | MT21304814 | IN | Primary |
Addresses
Primary practice location
5111 N Bend Dr
Fort Wayne, IN 46804-1753
Mailing address
6109 Shadow Ridge PL
Fort Wayne, IN 46804-4297
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 |
|---|---|---|---|
| MT21304814 | IN | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vital Living Therapeutic Massage, LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Vital Living WellSpa
- Nurse Massage Therapist (NMT)
- Fort Wayne, IN
- NPI 1790151157
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441152000000",
"number": "1083081400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6109 SHADOW RIDGE PL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468044297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5111 N BEND DR",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468041753",
"telephone_number": "260-436-8807"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REESE",
"first_name": "LAUREN",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-02",
"last_updated": "2015-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT21304814",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.