NPIMap

Organization Active NPI

Lakewood Ranch Medical Massage, LLC

Doing business as Mad Science Massage

  • Massage Therapist
  • Bradenton, FL
National Provider Identifier
1104356591
Registry record updated Jun 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA40424 Issued in FL
Legal business name
LAKEWOOD RANCH MEDICAL MASSAGE, LLC
Doing business as
Mad Science Massage
Practice address
9070 58TH Dr E Ste 102
Bradenton, FL 34202-6110
Phone
(941) 321-5311
Fax
(941) 321-5311
NPI assigned
Jun 18, 2017
Last updated
Jun 18, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2017

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

Authorized official

Name
Elizabeth Nicole Pugh, LMTNPI 1154492536
Title
Owner / Therapist
Phone
(941) 321-5311

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X MA40424 FL Primary

Addresses

Primary practice location

9070 58TH Dr E Ste 102
Bradenton, FL 34202-6110

Mailing address

11161 E State Road 70 Ste 110-360
Lakewood Ranch, FL 34202-9407
Phone (941) 321-5311

Other names 1

  • Mad Science Massage Doing business as

National Provider Directory

National Provider Directory

Locations

11161 State Road 70 E
Ste 110360
Lakewood Ranch, FL 34202

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1497744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497744000000",
    "number": "1104356591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11161 E STATE ROAD 70 STE 110-360",
            "city": "LAKEWOOD RANCH",
            "state": "FL",
            "postal_code": "342029407",
            "telephone_number": "941-321-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9070 58TH DR E STE 102",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342026110",
            "telephone_number": "941-321-5311",
            "fax_number": "941-321-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWOOD RANCH MEDICAL MASSAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-18",
        "last_updated": "2017-06-18",
        "status": "A",
        "authorized_official_last_name": "PUGH",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER / THERAPIST",
        "authorized_official_telephone_number": "941-321-5311",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA40424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mad Science Massage",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mad Science Massage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bradenton, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2017; 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.