Active NPI
Byron Wild, LMT
- Massage Therapist
- Washington, DC
National Provider Identifier
1760017545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2588
- Practice address
- 914 15TH St SE
Washington, DC 20003-3210 - Phone
- (646) 229-6763
- NPI assigned
- Mar 11, 2020
- Sex
- Male
- 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 | 2588 | DC | Primary |
Addresses
Primary practice location
914 15TH St SE
Washington, DC 20003-3210
Mailing address
914 15TH St SE
Washington, DC 20003-3210
Phone (646) 229-6763
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 |
|---|---|---|---|
| 2588 | DC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1583884800000",
"number": "1760017545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 15TH ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200033210",
"telephone_number": "646-229-6763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 15TH ST SE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200033210",
"telephone_number": "646-229-6763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILD",
"first_name": "BYRON",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-03-11",
"last_updated": "2020-03-11",
"certification_date": "2020-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "DC",
"license": "2588",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.