Active NPI
Mary C. Nettles, LMT
- Massage Therapist
- Irmo, SC
National Provider Identifier
1316193584
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 4530
- Practice address
- 7210L Broad River Rd
Irmo, SC 29063-7973 - Phone
- (803) 749-1576
- NPI assigned
- Aug 7, 2008
- Sex
- Female
- 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 | 4530 | SC | Primary |
Addresses
Primary practice location
7210L Broad River Rd
Irmo, SC 29063-7973
Mailing address
140 Willa Dr
Columbia, SC 29209-4353
Phone (803) 261-5319
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 |
|---|---|---|---|
| 4530 | SC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218067200000",
"number": "1316193584",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 WILLA DR",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292094353",
"telephone_number": "803-261-5319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7210L BROAD RIVER RD",
"city": "IRMO",
"state": "SC",
"postal_code": "290637973",
"telephone_number": "803-749-1576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETTLES",
"first_name": "MARY",
"middle_name": "C.",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-07",
"last_updated": "2008-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "SC",
"license": "4530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irmo, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.