Active NPI
Paula Black, LMT
- Massage Therapist
- Eustis, FL
National Provider Identifier
1386829455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA41889
- Practice address
- 2430 S Bay St
Eustis, FL 32726-6363 - Phone
- (352) 217-5913
- Fax
- (800) 878-6689
- NPI assigned
- Jan 8, 2008
- Last updated
- Sep 12, 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 | MA41889 | FL | Primary |
Addresses
Primary practice location
2430 S Bay St
Eustis, FL 32726-6363
Mailing address
37110 Shalimar Dr
Fruitland Park, FL 34731-5693
Phone (352) 217-5913
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C2910 | Other | FL | BCBS |
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 |
|---|---|---|---|
| MA41889 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347408000000",
"number": "1386829455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37110 SHALIMAR DR",
"city": "FRUITLAND PARK",
"state": "FL",
"postal_code": "347315693",
"telephone_number": "352-217-5913",
"fax_number": "800-878-6689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 S BAY ST",
"city": "EUSTIS",
"state": "FL",
"postal_code": "327266363",
"telephone_number": "352-217-5913",
"fax_number": "800-878-6689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "PAULA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-08",
"last_updated": "2012-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA41889",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "C2910",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eustis, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.