Active NPI
Lisa Matulka, MA83905
- Massage Therapist
- Bonita Springs, FL
National Provider Identifier
1538632062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA83905
- Practice address
- 3411 Bonita Beach Rd Ste 305
Bonita Springs, FL 34134-4155 - Phone
- (239) 529-7122
- NPI assigned
- Jan 8, 2019
- 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 | MA83905 | FL | Primary |
Addresses
Primary practice location
3411 Bonita Beach Rd Ste 305
Bonita Springs, FL 34134-4155
Mailing address
6020 Jonathans Bay Cir Apt 301
Fort Myers, FL 33908-7255
Phone (704) 860-4959
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 |
|---|---|---|---|
| MA83905 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546905600000",
"number": "1538632062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6020 JONATHANS BAY CIR APT 301",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339087255",
"telephone_number": "704-860-4959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3411 BONITA BEACH RD STE 305",
"city": "BONITA SPRINGS",
"state": "FL",
"postal_code": "341344155",
"telephone_number": "239-529-7122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATULKA",
"first_name": "LISA",
"credential": "MA83905",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-01-08",
"last_updated": "2019-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA83905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bonita Springs, FL
- Stephanie Massaro, LMHC
- Maternal Fetal Medine of SW Flordia
- Rajimon Mathai, R.PH.
- Melissa Deeks Matousek, LCSW
- Matthew P Powers MD PA (Wound Healing Center of Bonita)
- Maximum Achievers, LLC
- Frank Leonard Mazzella II, DC
- MC Fitness LLC (InMotion Fitness and Physical Therapy)
- Mark D McAllister, MD
- Donald M McCarren, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.