NPIMap

Organization Active NPI

Golden Professional Therapy Corp

  • Massage Therapist
  • Fort Myers, FL
National Provider Identifier
1457637498
Registry record updated Oct 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA63547 Issued in FL
Legal business name
GOLDEN PROFESSIONAL THERAPY CORP
Practice address
31 Barkley Cir
Suite 1B
Fort Myers, FL 33907-7628
Phone
(239) 931-4001
Fax
(239) 931-4002
NPI assigned
Oct 21, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Arnaldo De la Vega
Title
Vice President
Phone
(239) 931-4001

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X ME101292 FL
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X MA63547 FL Primary

Addresses

Primary practice location

31 Barkley Cir
Suite 1B
Fort Myers, FL 33907-7628

Mailing address

31 Barkley Cir
Suite 1B
Fort Myers, FL 33907-7628
Phone (239) 931-4001

Other identifiers 1

IdentifierTypeStateIssuer
000107700MedicaidFL

National Provider Directory

National Provider Directory

Locations

31 Barkley Cir
Ste 1B
Fort Myers, FL 33907
Phone (239) 931-4001

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1457637498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 BARKLEY CIR",
            "address_2": "SUITE 1B",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339077628",
            "telephone_number": "239-931-4001",
            "fax_number": "239-931-4002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 BARKLEY CIR",
            "address_2": "SUITE 1B",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339077628",
            "telephone_number": "239-931-4001",
            "fax_number": "239-931-4002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN PROFESSIONAL THERAPY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "DE LA VEGA",
        "authorized_official_first_name": "ARNALDO",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "239-931-4001",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME101292",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA63547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000107700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.