Fredrick Lee Eagles

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

2002017980 Issued in MO

Practice address

1200 E Woodhurst Dr Ste Q100
Springfield, MO 65804-4240

Phone

(417) 877-1300

NPI assigned

Oct 10, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1669014767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR STE Q100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044240",
            "telephone_number": "417-877-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E WOODHURST DR STE Q100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658044240",
            "telephone_number": "417-877-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EAGLES",
        "first_name": "FREDRICK",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2472E0500X",
            "taxonomy_group": "",
            "desc": "Technician, Other, EEG",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MO",
            "license": "2002017980",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael S Dye Sr., LMSW
• Dynamic Dna Laboratories, LLC
• Denniese Dysart, M.S., L.P.C.
• Eagle Crest Counseling Center, Inc.
• Eagles Wings Counseling LLC
• Brendan Michael Earley, PHARMD
• Brandy M Earls, CD(DONA)
• Daniel J. Earnest, PA-C
• Easter Seals Midwest
• Alyssa Easter, MD

• Massage Therapist in Springfield, MO
• Providers in Springfield, MO by specialty
• Massage Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.

Verify at the official NPI Registry.