Active NPI
Bernard Habaluyas Mamuyac, LMT
- Massage Therapist
- Port Saint Lucie, FL
National Provider Identifier
1356588909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA50322
- Practice address
- 1286 SW Avens St
Port Saint Lucie, FL 34983-2506 - Phone
- (772) 321-9185
- Fax
- (772) 785-9094
- NPI assigned
- Jan 17, 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 | MA50322 | FL | Primary |
Addresses
Primary practice location
1286 SW Avens St
Port Saint Lucie, FL 34983-2506
Mailing address
1286 SW Avens St
Port Saint Lucie, FL 34983-2506
Phone (772) 321-9185
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 |
|---|---|---|---|
| MA50322 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1232150400000",
"number": "1356588909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1286 SW AVENS ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349832506",
"telephone_number": "772-321-9185",
"fax_number": "772-785-9094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1286 SW AVENS ST",
"city": "PORT SAINT LUCIE",
"state": "FL",
"postal_code": "349832506",
"telephone_number": "772-321-9185",
"fax_number": "772-785-9094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMUYAC",
"first_name": "BERNARD",
"middle_name": "HABALUYAS",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-01-17",
"last_updated": "2009-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA50322",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Saint Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.