Individual provider Active NPI

Bruce Vaught, LMT

  • Massage Therapist
  • Mesa, AZ
National Provider Identifier
1104470285
Registry record updated Apr 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
24762 Issued in AZ
Practice address
4135 S Power Rd Ste 110
Mesa, AZ 85212-3625
Phone
(623) 326-0545
NPI assigned
Jul 28, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 24762 AZ Primary

Addresses

Primary practice location

4135 S Power Rd Ste 110
Mesa, AZ 85212-3625

Mailing address

4202 E Broadway Rd Unit 135
Mesa, AZ 85206-1067
Phone (623) 326-0545

Other practice location 1

6671 E Baseline Rd Ste 126
Mesa, AZ 85206-4328
Phone (623) 326-0545

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

NPI Registry JSON

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

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744329600000",
    "number": "1104470285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 E BROADWAY RD UNIT 135",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061067",
            "telephone_number": "623-326-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4135 S POWER RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852123625",
            "telephone_number": "623-326-0545"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6671 E Baseline Rd Ste 126",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852064328",
            "country_code": "US",
            "telephone_number": "623-326-0545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAUGHT",
        "first_name": "BRUCE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-28",
        "last_updated": "2025-04-11",
        "certification_date": "2025-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "24762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2025; 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.