Active NPI
Matthew Roger Weaver, LMT
- Massage Therapist
- Castleton, NY
National Provider Identifier
1235381807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 013854-1
- Practice address
- 1523 Columbia Turnpike
Serenity Day Spa
Castleton, NY 12033-9544 - Phone
- (518) 479-5680
- NPI assigned
- Oct 15, 2008
- 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 | 013854-1 | NY | Primary |
Addresses
Primary practice location
1523 Columbia Turnpike
Serenity Day Spa
Castleton, NY 12033-9544
Mailing address
171 Teal Road
Sand Lake, NY 12153
Phone (518) 674-4033
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 |
|---|---|---|---|
| 013854-1 | NY | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1224028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224028800000",
"number": "1235381807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 TEAL ROAD",
"city": "SAND LAKE",
"state": "NY",
"postal_code": "12153",
"telephone_number": "518-674-4033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1523 COLUMBIA TURNPIKE",
"address_2": "SERENITY DAY SPA",
"city": "CASTLETON",
"state": "NY",
"postal_code": "120339544",
"telephone_number": "518-479-5680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEAVER",
"first_name": "MATTHEW",
"middle_name": "ROGER",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-10-15",
"last_updated": "2008-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "013854-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Castleton, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.