Diversified Therapeutics Inc

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA0018459 Issued in FL

Legal business name

DIVERSIFIED THERAPEUTICS INC

Practice address

613 SE Central Parkway
Stuart, FL 34994

Phone

(772) 221-7638

Fax

(772) 221-7628

NPI assigned

Mar 17, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Calvin Lee Jackson, LMT, CPT

Title

President/Licensed Massage Therapis

Phone

(772) 221-7638

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erica Wassuta, LMT

  • Massage Therapist
  • Stuart, FL
  • NPI 1669615209
  NPD (past)

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

{
    "created_epoch": "1237248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237248000000",
    "number": "1700027984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 SE CENTRAL PARKWAY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "34994",
            "telephone_number": "772-221-7638",
            "fax_number": "772-221-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 SE CENTRAL PARKWAY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "34994",
            "telephone_number": "772-221-7638",
            "fax_number": "772-221-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSIFIED THERAPEUTICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-17",
        "last_updated": "2009-03-17",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CALVIN",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT/LICENSED MASSAGE THERAPIS",
        "authorized_official_telephone_number": "772-221-7638",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMT, CPT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA0018459",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "C8068",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mario Disney
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• District Diagnostic LLC
• Niccia Ditrapano
• Diverse Family Solutions
• Gaia Dixon-Pollard
• Cassandra Lena Dixon, COTA
• Latrebah Ann Dixson, RBT
• Monique Louise Dizon
• Dna Comprehensive Therapy Services, LLC

• Massage Therapist in Stuart, FL
• Providers in Stuart, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; 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.