Active NPI
Mark Wayne Larson, MT
- Massage Therapist
- Ooltewah, TN
National Provider Identifier
1265876056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 9061
- Practice address
- 10093 Sunny LN
Ooltewah, TN 37363-8487 - Phone
- (423) 838-8906
- NPI assigned
- Apr 23, 2013
- 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 | 9061 | TN | Primary |
Addresses
Primary practice location
10093 Sunny LN
Ooltewah, TN 37363-8487
Mailing address
PO Box 1505
10093 Sunny Lane
Collegedale, TN 37315-1505
Phone (423) 838-8906
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
- Credentials
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9061 | TN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1366675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1366675200000",
"number": "1265876056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1505",
"address_2": "10093 SUNNY LANE",
"city": "COLLEGEDALE",
"state": "TN",
"postal_code": "373151505",
"telephone_number": "423-838-8906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10093 SUNNY LN",
"city": "OOLTEWAH",
"state": "TN",
"postal_code": "373638487",
"telephone_number": "423-838-8906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "MARK",
"middle_name": "WAYNE",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-23",
"last_updated": "2013-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TN",
"license": "9061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ooltewah, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.