Active NPI
Larry Jason Reagor, LMT
- Massage Therapist
- Newnan, GA
National Provider Identifier
1427320522
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT006894
- Practice address
- 29 Vista Bella Way
Newnan, GA 30265-6014 - Phone
- (770) 584-0003
- NPI assigned
- Feb 4, 2012
- 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 | MT006894 | GA | Primary |
Addresses
Primary practice location
29 Vista Bella Way
Newnan, GA 30265-6014
Mailing address
29 Vista Bella Way
Newnan, GA 30265-6014
Phone (770) 584-0003
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 |
|---|---|---|---|
| MT006894 | GA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1328313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476921600000",
"number": "1427320522",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29 VISTA BELLA WAY",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302656014",
"telephone_number": "770-584-0003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29 VISTA BELLA WAY",
"city": "NEWNAN",
"state": "GA",
"postal_code": "302656014",
"telephone_number": "770-584-0003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGOR",
"first_name": "LARRY",
"middle_name": "JASON",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-04",
"last_updated": "2016-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT006894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newnan, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.