Syble Davis - Pettycord, MTI – Massage Therapist

Key facts

NPI: 1386879112
Entity type: Individual (NPI type 1)
Primary specialty: Massage Therapist 225700000X
License: 1316 (AR)
Practice address: 690 Tate St
Camden, AR 71701-6180
Phone: (870) 231-9515
NPI assigned: May 22, 2009
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Touch of Health Care Therapy Massage Therapist · Camden, AR · NPI 1114152899

NPD (past) MASSAGE THERAPIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1316	AR	MD	Registered Dietitian

Practice roles

Organization	Specialty	Status	New patients
Touch of Health Care Therapy	Massage Therapist	Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Massage Therapist	225700000X	1316	AR	Yes

Addresses

Primary practice location

690 Tate St
Camden, AR 71701-6180

Mailing address

PO Box 1420
Camden, AR 71711-2420
Phone (870) 231-9515

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 6, 2013.

{
    "created_epoch": "1242950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362528000000",
    "number": "1386879112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1420",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717112420",
            "telephone_number": "870-231-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "690 TATE ST",
            "city": "CAMDEN",
            "state": "AR",
            "postal_code": "717016180",
            "telephone_number": "870-231-9515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS - PETTYCORD",
        "first_name": "SYBLE",
        "credential": "MTI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-05-22",
        "last_updated": "2013-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "AR",
            "license": "1316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, AR

All providers in Camden, AR · Massage Therapist in Arkansas

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2013. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.