Individual provider Active NPI

Terese R Donovan, L.M.T., M.M.P.

  • Massage Therapist
  • Henderson, NV
National Provider Identifier
1619350063
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
NVMT.307 Issued in NV
Practice address
127 S Water St
Henderson, NV 89015-7221
Phone
(702) 497-2838
Fax
(702) 497-2838
NPI assigned
Jul 2, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X NVMT.307 NV Primary

Addresses

Primary practice location

127 S Water St
Henderson, NV 89015-7221

Mailing address

643 Marlberry PL
Henderson, NV 89015-7474
Phone (702) 497-2838

Other practice location 1

3676 Waikiki Ave
Las Vegas, NV 89104-4663
Phone (702) 497-2838

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

LicenseStateTypeSpecialty
NVMT.307NVMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1619350063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "643 MARLBERRY PL",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157474",
            "telephone_number": "702-497-2838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 S WATER ST",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157221",
            "telephone_number": "702-497-2838",
            "fax_number": "702-497-2838"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3676 Waikiki Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891044663",
            "country_code": "US",
            "telephone_number": "702-497-2838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DONOVAN",
        "first_name": "TERESE",
        "middle_name": "R",
        "credential": "L.M.T., M.M.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-02",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NV",
            "license": "NVMT.307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; 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.