Active NPI
Bryan Devaughn
- Massage Therapist
- Baltimore, MD
National Provider Identifier
1356804280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- R02802
- Practice address
- 1120 N Charles St Ste 400
Baltimore, MD 21201-5594 - Phone
- (410) 375-0032
- NPI assigned
- Apr 8, 2019
- Last updated
- Apr 8, 2019
- 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 | R02802 | MD | Primary |
Addresses
Primary practice location
1120 N Charles St Ste 400
Baltimore, MD 21201-5594
Mailing address
5108 Plymouth Rd
Baltimore, MD 21214-2151
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 |
|---|---|---|---|
| R02802 | MD | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554681600000",
"number": "1356804280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5108 PLYMOUTH RD",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212142151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1120 N CHARLES ST STE 400",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212015594",
"telephone_number": "410-375-0032"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVAUGHN",
"first_name": "BRYAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-08",
"last_updated": "2019-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MD",
"license": "R02802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.