Active NPI
Wayne Alan Brack, LMT, NCMTB
- Massage Therapist
- Port Saint Lucie, FL
National Provider Identifier
1164720355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA 60306
- Practice address
- 236 SW Port St Lucie Blvd
Port Saint Lucie, FL 34984-5044 - Phone
- (772) 807-1785
- Fax
- (772) 905-8314
- NPI assigned
- Mar 11, 2011
- Sex
- Male
- 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 | MA 60306 | FL | Primary |
Addresses
Primary practice location
236 SW Port St Lucie Blvd
Port Saint Lucie, FL 34984-5044
Mailing address
236 SW Port St Lucie Blvd
Port Saint Lucie, FL 34984-5044
Phone (772) 807-1785
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 |
|---|---|---|---|
| MA 60306 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299801600000",
"number": "1164720355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "236 SW PORT ST LUCIE BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349845044",
"telephone_number": "772-807-1785",
"fax_number": "772-905-8314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "236 SW PORT ST LUCIE BLVD",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349845044",
"telephone_number": "772-807-1785",
"fax_number": "772-905-8314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRACK",
"first_name": "WAYNE",
"middle_name": "ALAN",
"name_prefix": "Mr.",
"credential": "LMT, NCMTB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-03-11",
"last_updated": "2011-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA 60306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.