Active NPI
Sean Fagan
- Massage Therapist
- Gloucester, MA
National Provider Identifier
1588025282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12492
- Practice address
- 10 Western Ave
Gloucester, MA 01930-3645 - Phone
- (978) 381-5636
- NPI assigned
- Mar 9, 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 | 12492 | MA | Primary |
Addresses
Primary practice location
10 Western Ave
Gloucester, MA 01930-3645
Mailing address
10 Western Ave
Gloucester, MA 01930-3645
Phone (978) 381-5636
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 |
|---|---|---|---|
| 12492 | MA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1457481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457481600000",
"number": "1588025282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 WESTERN AVE",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019303645",
"telephone_number": "978-381-5636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 WESTERN AVE",
"city": "GLOUCESTER",
"state": "MA",
"postal_code": "019303645",
"telephone_number": "978-381-5636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAGAN",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-09",
"last_updated": "2016-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "12492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gloucester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.