Active NPI
Sandra Kay Waller, LMT
- Massage Therapist
- Panama City, FL
National Provider Identifier
1144404807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA36353
- Practice address
- 1714 W 23Rd Street
Suite E
Panama City, FL 32405-2003 - Phone
- (850) 276-1932
- Fax
- (850) 769-8689
- NPI assigned
- Dec 18, 2007
- Last updated
- Dec 18, 2007
- Sex
- Female
- 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 | MA36353 | FL | Primary |
Addresses
Primary practice location
1714 W 23Rd Street
Suite E
Panama City, FL 32405-2003
Mailing address
2143 W 29TH Street
Panama City, FL 32405-2003
Phone (850) 276-1932
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 |
|---|---|---|---|
| MA36353 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay Massage Therapy Inc | 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.
-
- Massage Therapist
- Panama City, FL
- NPI 1124209788
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197936000000",
"number": "1144404807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2143 W 29TH STREET",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324052003",
"telephone_number": "850-276-1932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1714 W 23RD STREET",
"address_2": "SUITE E",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324052003",
"telephone_number": "850-276-1932",
"fax_number": "850-769-8689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "SANDRA",
"middle_name": "KAY",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-18",
"last_updated": "2007-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA36353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.