Active NPI
Beverly Wilson, LMT
- Massage Therapist
- Atlanta, GA
National Provider Identifier
1720386451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT006291
- Practice address
- 700 Dalrymple Rd
203
Atlanta, GA 30328-1414 - Phone
- (404) 940-0784
- NPI assigned
- Mar 3, 2011
- Sex
- Female
- 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 | MT006291 | GA | Primary |
Addresses
Primary practice location
700 Dalrymple Rd
203
Atlanta, GA 30328-1414
Mailing address
PO Box 291
Ellenwood, GA 30294-0291
Phone (404) 940-0784
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
| License | State | Type | Specialty |
|---|---|---|---|
| MT006291 | GA | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Roasie Knows LLC | Massage Therapist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Massage Therapist
- Anniston, AL
- NPI 1093498461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428969600000",
"number": "1720386451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 291",
"city": "ELLENWOOD",
"state": "GA",
"postal_code": "302940291",
"telephone_number": "404-940-0784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 DALRYMPLE RD",
"address_2": "203",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303281414",
"telephone_number": "404-940-0784"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "BEVERLY",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-03",
"last_updated": "2015-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "GA",
"license": "MT006291",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.