Active NPI
Athena Wagner
- Massage Therapist
- Leesburg, VA
National Provider Identifier
1770305617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0019019362
- Practice address
- 821 S King St Ste B
Leesburg, VA 20175-3914 - Phone
- (571) 249-2344
- NPI assigned
- Oct 31, 2024
- Last updated
- Oct 31, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 0019019362 | VA | Primary |
Addresses
Primary practice location
821 S King St Ste B
Leesburg, VA 20175-3914
Mailing address
67 Willow Lake LN # B1
Bluemont, VA 20135-5252
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 |
|---|---|---|---|
| 0019019362 | VA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730332800000",
"number": "1770305617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 WILLOW LAKE LN # B1",
"city": "BLUEMONT",
"state": "VA",
"postal_code": "201355252"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "821 S KING ST STE B",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201753914",
"telephone_number": "571-249-2344"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ATHENA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-10-31",
"last_updated": "2024-10-31",
"certification_date": "2024-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "VA",
"license": "0019019362",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.