Active NPI
Shaoyu Wan
- Massage Therapist
- Fort Worth, TX
National Provider Identifier
1821685728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT124699
- Practice address
- 1504 Smilax Ave
Fort Worth, TX 76111-1428 - Phone
- (682) 429-3480
- NPI assigned
- Dec 25, 2020
- 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 | MT124699 | TX | Primary |
Addresses
Primary practice location
1504 Smilax Ave
Fort Worth, TX 76111-1428
Mailing address
1504 Smilax Ave
Fort Worth, TX 76111-1428
Phone (682) 429-3480
Other names 1
- Swan Wan
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 |
|---|---|---|---|
| MT124699 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1608854400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1608854400000",
"number": "1821685728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1504 SMILAX AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761111428",
"telephone_number": "682-429-3480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1504 SMILAX AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761111428",
"telephone_number": "682-429-3480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "SHAOYU",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-25",
"last_updated": "2020-12-25",
"certification_date": "2020-12-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT124699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SWAN",
"last_name": "WAN",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 25, 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.