Anita Lyn Peterson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

16662 Issued in OR

Practice address

6645 Gleneden Beach Loop
Gleneden Beach, OR 97388-9700

Phone

(541) 764-3797

NPI assigned

May 13, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1589328000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589328000000",
    "number": "1558983569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94",
            "city": "DEPOE BAY",
            "state": "OR",
            "postal_code": "973410094",
            "telephone_number": "541-961-8657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6645 GLENEDEN BEACH LOOP",
            "city": "GLENEDEN BEACH",
            "state": "OR",
            "postal_code": "973889700",
            "telephone_number": "541-764-3797"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23 NE Williams Ave",
            "address_purpose": "LOCATION",
            "city": "Depoe Bay",
            "state": "OR",
            "postal_code": "973411979",
            "country_code": "US",
            "telephone_number": "541-961-8657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ANITA",
        "middle_name": "LYN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-13",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "16662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Gleneden Beach, OR
• Providers in Gleneden Beach, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.