Mythic Massage LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

MYTHIC MASSAGE LLC

Practice address

5701 Executive Center Dr Ste 350
Charlotte, NC 28212-8847

Phone

(704) 323-6718

NPI assigned

Jun 3, 2020

Last updated

Nov 8, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Meww Gomez, LMBTNPI 1922629161

Title

Owner

Phone

(704) 323-6718

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Meww Gomez, LMBT

  • Massage Therapist
  • Charlotte, NC
  • NPI 1922629161
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699401600000",
    "number": "1093339269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5701 EXECUTIVE CENTER DR STE 350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282128847",
            "telephone_number": "704-323-6718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5701 EXECUTIVE CENTER DR STE 350",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282128847",
            "telephone_number": "704-323-6718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYTHIC MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-03",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "MEWW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-323-6718",
        "authorized_official_credential": "LMBT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laquita D. Myles, RN
• Sesha Pavan Kumar Myneni, MD
• Myps LLC (MY Dentists Latrobe)
• William Michael Myrick, MD
• Mysupport
• N Ahmad DDS I PA
• N Ahmad DDS II PA
• N Phases
• N-Ovative Care Services
• N2 Potential

• Clinic/Center in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.