Active NPI
Corwin Randolph Shirley, LMT
- Massage Therapist
- Leland, NC
National Provider Identifier
1619792991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 19204
- Practice address
- 8060 Purchase PL NE Unit 4
Leland, NC 28451-0977 - Phone
- (910) 725-4325
- NPI assigned
- Nov 20, 2024
- 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 | 19204 | NC | Primary |
Addresses
Primary practice location
8060 Purchase PL NE Unit 4
Leland, NC 28451-0977
Mailing address
8060 Purchase PL NE Unit 4
Leland, NC 28451-0977
Phone (910) 233-9627
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1732060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732060800000",
"number": "1619792991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8060 PURCHASE PL NE UNIT 4",
"city": "LELAND",
"state": "NC",
"postal_code": "284510977",
"telephone_number": "910-233-9627"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8060 PURCHASE PL NE UNIT 4",
"city": "LELAND",
"state": "NC",
"postal_code": "284510977",
"telephone_number": "910-725-4325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIRLEY",
"first_name": "CORWIN",
"middle_name": "RANDOLPH",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-11-20",
"last_updated": "2024-11-20",
"certification_date": "2024-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NC",
"license": "19204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leland, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.