Active NPI
Marquis Mangrum
- Massage Therapist
- Hewitt, TX
National Provider Identifier
1295427979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT113672
- Practice address
- 1217 S Hewitt Dr
Hewitt, TX 76643-3200 - Phone
- (254) 723-2400
- NPI assigned
- May 22, 2023
- 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 | MT113672 | TX | Primary |
Addresses
Primary practice location
1217 S Hewitt Dr
Hewitt, TX 76643-3200
Mailing address
1217 S Hewitt Dr
Hewitt, TX 76643-3200
Phone (254) 723-2400
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 |
|---|---|---|---|
| MT113672 | TX | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elite Wellness Waco LLC | Single Specialty | Current | Accepting new patients |
Locations
1217 S Hewitt Dr
Hewitt, TX 76643
Phone (254) 315-0771
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684713600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1295427979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1217 S HEWITT DR",
"city": "HEWITT",
"state": "TX",
"postal_code": "766433200",
"telephone_number": "254-723-2400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1217 S HEWITT DR",
"city": "HEWITT",
"state": "TX",
"postal_code": "766433200",
"telephone_number": "254-723-2400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANGRUM",
"first_name": "MARQUIS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-05-22",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT113672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hewitt, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.