Active NPI
Lisa L Roberson, LMT
- Massage Therapist
- Homewood, IL
National Provider Identifier
1437912664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.015647
- Practice address
- 1820 Ridge Rd Ste 306a
Homewood, IL 60430-1759 - Phone
- (708) 918-3588
- NPI assigned
- Jan 31, 2024
- 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 | 227.015647 | IL | Primary |
Addresses
Primary practice location
1820 Ridge Rd Ste 306a
Homewood, IL 60430-1759
Mailing address
1820 Ridge Rd Ste 306a
Homewood, IL 60430-1759
Phone (708) 918-3588
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 |
|---|---|---|---|
| 227.015647 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711929600000",
"number": "1437912664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1820 RIDGE RD STE 306A",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604301759",
"telephone_number": "708-918-3588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1820 RIDGE RD STE 306A",
"city": "HOMEWOOD",
"state": "IL",
"postal_code": "604301759",
"telephone_number": "708-918-3588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERSON",
"first_name": "LISA",
"middle_name": "L",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-31",
"last_updated": "2024-04-01",
"certification_date": "2024-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.015647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Homewood, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.