Active NPI
Derrick Michael Brantley, LMT
- Massage Therapist
- Orange City, FL
National Provider Identifier
1477006195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 79136
- Practice address
- 572 Hamilton Ave
Orange City, FL 32763-4610 - Phone
- (386) 801-0642
- NPI assigned
- Jul 28, 2016
- Last updated
- Jul 28, 2016
- 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 | 79136 | FL | Primary |
Addresses
Primary practice location
572 Hamilton Ave
Orange City, FL 32763-4610
Mailing address
572 Hamilton Ave
Orange City, FL 32763-4610
Phone (386) 801-0642
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 |
|---|---|---|---|
| 79136 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1477006195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "572 HAMILTON AVE",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327634610",
"telephone_number": "386-801-0642"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "572 HAMILTON AVE",
"city": "ORANGE CITY",
"state": "FL",
"postal_code": "327634610",
"telephone_number": "386-801-0642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANTLEY",
"first_name": "DERRICK",
"middle_name": "MICHAEL",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-28",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "79136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.