Active NPI
Victoria Lea Bothman, LMT
- Massage Therapist
- Saint Louis, MO
National Provider Identifier
1154495919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2002002533
- Practice address
- 7902 Big Bend Blvd
Saint Louis, MO 63119-2704 - Phone
- (618) 791-8742
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 2002002533 | MO | Primary |
Addresses
Primary practice location
7902 Big Bend Blvd
Saint Louis, MO 63119-2704
Mailing address
108 Maple St
Edwardsville, IL 62025-1441
Phone (618) 791-8742
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 |
|---|---|---|---|
| 2002002533 | MO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154495919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "108 MAPLE ST",
"city": "EDWARDSVILLE",
"state": "IL",
"postal_code": "620251441",
"telephone_number": "618-791-8742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7902 BIG BEND BLVD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631192704",
"telephone_number": "618-791-8742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTHMAN",
"first_name": "VICTORIA",
"middle_name": "LEA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2002002533",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.