Active NPI
Edward Roberts
- Massage Therapist
- Port Charlotte, FL
National Provider Identifier
1265046676
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA76208
- Practice address
- 18134 Garvin Ave
Port Charlotte, FL 33948-1914 - Phone
- (617) 653-6308
- NPI assigned
- Sep 2, 2020
- 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 | MA76208 | FL | Primary |
Addresses
Primary practice location
18134 Garvin Ave
Port Charlotte, FL 33948-1914
Mailing address
18134 Garvin Ave
PT Charlotte, FL 33948-1914
Phone (617) 653-6308
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 |
|---|---|---|---|
| MA76208 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599004800000",
"number": "1265046676",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18134 GARVIN AVE",
"city": "PT CHARLOTTE",
"state": "FL",
"postal_code": "339481914",
"telephone_number": "617-653-6308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18134 GARVIN AVE",
"city": "PORT CHARLOTTE",
"state": "FL",
"postal_code": "339481914",
"telephone_number": "617-653-6308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "EDWARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-09-02",
"last_updated": "2020-09-02",
"certification_date": "2020-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA76208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Charlotte, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.