Active NPI
Nicole Renee Manvel Walls, LMT
- Massage Therapist
- Winter Garden, FL
National Provider Identifier
1306181672
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA 54962
- Practice address
- 213 S Dillard St Ste 110G
Winter Garden, FL 34787-3596 - Phone
- (407) 877-6061
- NPI assigned
- Nov 28, 2012
- Sex
- Female
- 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 | MA 54962 | FL | Primary |
Addresses
Primary practice location
213 S Dillard St Ste 110G
Winter Garden, FL 34787-3596
Mailing address
1131 Railside Way
Oakland, FL 34787-8935
Phone (404) 454-3063
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 |
|---|---|---|---|
| MA 54962 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354060800000",
"number": "1306181672",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1131 RAILSIDE WAY",
"city": "OAKLAND",
"state": "FL",
"postal_code": "347878935",
"telephone_number": "404-454-3063"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 S DILLARD ST STE 110G",
"city": "WINTER GARDEN",
"state": "FL",
"postal_code": "347873596",
"telephone_number": "407-877-6061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANVEL WALLS",
"first_name": "NICOLE",
"middle_name": "RENEE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-11-28",
"last_updated": "2012-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA 54962",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Garden, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.