Footprints on the Moon Massage and Bodywork, LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MM32405 Issued in FL

Legal business name

FOOTPRINTS ON THE MOON MASSAGE AND BODYWORK, LLC

Practice address

1312 Illinois Ave
Suite E
Saint Cloud, FL 34769-4506

Phone

(407) 436-2122

NPI assigned

Jul 1, 2014

Organization subpart

No

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

Authorized official

Name

Samantha Jo Fagnant, LMTNPI 1396179578

Title

Owner/Therapist

Phone

(407) 436-2122

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Samantha Jo Fagnant, LMT

  • Massage Therapist
  • Saint Cloud, FL
  • NPI 1396179578
  NPD (past) Authorized official

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

{
    "created_epoch": "1404172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404172800000",
    "number": "1760898506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 ILLINOIS AVE",
            "address_2": "SUITE E",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694506",
            "telephone_number": "407-436-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 ILLINOIS AVE",
            "address_2": "SUITE E",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347694506",
            "telephone_number": "407-436-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOOTPRINTS ON THE MOON MASSAGE AND BODYWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-01",
        "last_updated": "2014-07-01",
        "status": "A",
        "authorized_official_last_name": "FAGNANT",
        "authorized_official_first_name": "SAMANTHA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "407-436-2122",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MM32405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fonseca Pediatrics LLC
• Felipe Fonseca, LMHC, MCAP
• Kaitlyn M Fonseca
• Ramon Augusto Fonseca, M.D.
• Jessica Erin Foor, P.T.A.
• Lynden Alfred Forbes
• Mikel Forero
• Claribel Fortuno, RN
• Kelsey Foster
• Bryce Foulke

• Massage Therapist in Saint Cloud, FL
• Providers in Saint Cloud, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2014; 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.