Active NPI
Alfred Medina, L.M.T.
- Massage Therapist
- Davie, FL
National Provider Identifier
1306074117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 46042
- Practice address
- 4691 S University Dr
Davie, FL 33328-3817 - Phone
- (954) 652-9804
- NPI assigned
- Jun 30, 2009
- 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 | 46042 | FL | Primary |
Addresses
Primary practice location
4691 S University Dr
Davie, FL 33328-3817
Mailing address
4984 SW 158TH Way
Miramar, FL 33027-5607
Phone (954) 652-9804
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 |
|---|---|---|---|
| 46042 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246320000000",
"number": "1306074117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4984 SW 158TH WAY",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330275607",
"telephone_number": "954-652-9804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4691 S UNIVERSITY DR",
"city": "DAVIE",
"state": "FL",
"postal_code": "333283817",
"telephone_number": "954-652-9804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "ALFRED",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-06-30",
"last_updated": "2009-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "46042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.