Active NPI
Tyson Reed Johnston
- Massage Therapist
- Bryan, TX
National Provider Identifier
1093041741
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT105386
- Practice address
- 3001 Wildflower Dr
611
Bryan, TX 77802-3061 - Phone
- (979) 774-4343
- NPI assigned
- Oct 29, 2009
- Last updated
- Nov 9, 2009
- Sex
- Male
- 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 | MT105386 | TX | Primary |
Addresses
Primary practice location
3001 Wildflower Dr
611
Bryan, TX 77802-3061
Mailing address
3001 Wildflower Dr
Suite 611
College Station, TX 77845-1609
Phone (979) 774-4343
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 |
|---|---|---|---|
| MT105386 | TX | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Interest 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1256774400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1257724800000",
"number": "1093041741",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 WILDFLOWER DR",
"address_2": "SUITE 611",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778451609",
"telephone_number": "979-774-4343"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 WILDFLOWER DR",
"address_2": "611",
"city": "BRYAN",
"state": "TX",
"postal_code": "778023061",
"telephone_number": "979-774-4343"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "TYSON",
"middle_name": "REED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-29",
"last_updated": "2009-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT105386",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.