Active NPI
Charles H. Lubeck, LMT
- Massage Therapist
- Evans, GA
National Provider Identifier
1134311343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT002464
- Practice address
- 608 Ponder Place Dr
Evans, GA 30809-3185 - Phone
- (706) 733-4344
- NPI assigned
- Aug 11, 2007
- Sex
- Male
- Sole proprietor
- No
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 | MT002464 | GA | Primary |
Addresses
Primary practice location
608 Ponder Place Dr
Evans, GA 30809-3185
Mailing address
312 Rabun Valley LN
Martinez, GA 30907-9523
Phone (706) 733-4344
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 |
|---|---|---|---|
| MT002464 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1186790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1186790400000",
"number": "1134311343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "312 RABUN VALLEY LN",
"city": "MARTINEZ",
"state": "GA",
"postal_code": "309079523",
"telephone_number": "706-733-4344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "608 PONDER PLACE DR",
"city": "EVANS",
"state": "GA",
"postal_code": "308093185",
"telephone_number": "706-733-4344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUBECK",
"first_name": "CHARLES",
"middle_name": "H.",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-11",
"last_updated": "2007-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT002464",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.