Active NPI
Frederick Nelson
- Massage Therapist
- Phoenix, AZ
National Provider Identifier
1467764837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT-00194P
- Practice address
- 4113 N 7TH Ave
Phoenix, AZ 85013-3071 - Phone
- (602) 631-9698
- NPI assigned
- Jul 13, 2010
- 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 | MT-00194P | AZ | Primary |
Addresses
Primary practice location
4113 N 7TH Ave
Phoenix, AZ 85013-3071
Mailing address
5953 W Aurora Dr
Glendale, AZ 85308-6357
Phone (623) 670-4316
Other names 1
- Rick Nelson
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 |
|---|---|---|---|
| MT-00194P | AZ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278979200000",
"number": "1467764837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5953 W AURORA DR",
"city": "GLENDALE",
"state": "AZ",
"postal_code": "853086357",
"telephone_number": "623-670-4316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4113 N 7TH AVE",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850133071",
"telephone_number": "602-631-9698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "FREDERICK",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-07-13",
"last_updated": "2010-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "MT-00194P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "RICK",
"last_name": "NELSON",
"credential": "LMT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.