Individual provider Active NPI

Renisha Williams, LMT/COSMETOLOGIST

  • Prosthetic/Orthotic Supplier
  • Tempe, AZ
National Provider Identifier
1174823082
Registry record updated Jun 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
19400823 Issued in AZ
Practice address
2747 W Southern Ave
Ste. 7
Tempe, AZ 85282-4249
Phone
(602) 437-3772
NPI assigned
Oct 26, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MT-03688P AZ
Prosthetic/Orthotic Supplier 335E00000X 19400823 AZ Primary

Addresses

Primary practice location

2747 W Southern Ave
Ste. 7
Tempe, AZ 85282-4249

Mailing address

2747 W Southern Ave Ste 7
Tempe, AZ 85282-4240
Phone (602) 312-4247

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

LicenseStateTypeSpecialty
MT-03688PAZMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782086400000",
    "number": "1174823082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2747 W SOUTHERN AVE STE 7",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852824240",
            "telephone_number": "602-312-4247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2747 W SOUTHERN AVE",
            "address_2": "STE. 7",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852824249",
            "telephone_number": "602-437-3772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RENISHA",
        "credential": "LMT/COSMETOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-10-26",
        "last_updated": "2026-06-22",
        "certification_date": "2026-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "MT-03688P",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "AZ",
            "license": "19400823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tempe, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2026; 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.