Berenice Maldonado, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

14753 Issued in NC

Practice address

100 Pavilion Way Ste E
Southern Pines, NC 28387-4560

Phone

(910) 315-0402

NPI assigned

Mar 31, 2022

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

Electronic endpoints 1

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": "1648684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1679213169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PAVILION WAY STE E",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874560",
            "telephone_number": "910-315-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PAVILION WAY STE E",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283874560",
            "telephone_number": "910-315-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALDONADO",
        "first_name": "BERENICE",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-31",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NC",
            "license": "14753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.thegreatmassage.com/",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "100 Pavilion Way Ste E",
            "city": "Southern Pines",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283874560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Massage Therapist in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Massage Therapist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2022; 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.