Larry Wayne Robertson, LICENSED MASSAGE

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT037344 Issued in TX

Practice address

116 E South St
Longview, TX 75601-7437

Phone

(903) 230-1911

NPI assigned

Sep 29, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Copper Tree Retreat Unlimited LLC

  • Massage Therapist
  • Longview, TX
  • NPI 1689411969
  NPD

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

{
    "created_epoch": "1695945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695945600000",
    "number": "1720868581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E SOUTH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756017437",
            "telephone_number": "903-230-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E SOUTH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756017437",
            "telephone_number": "903-230-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "LARRY",
        "middle_name": "WAYNE",
        "credential": "LICENSED MASSAGE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-29",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": "MT037344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kylie Ann Roberts, PT,DPT
• Michael Christopher Roberts, MD
• Rhonda Roberts
• Scott Christopher Roberts
• Deatra Robertson
• James Ray Robinette, CRNA
• Judy Robinson
• Justin Robinson
• Kayli Elizabeth Robison, FNP
• Damaris Rodgers

• Massage Therapist in Longview, TX
• Providers in Longview, TX by specialty
• Massage Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; 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.