NPIMap

Individual provider Active NPI

Stephanie Florin, C.M.T.

  • Massage Therapist
  • Fort Wayne, IN
National Provider Identifier
1851775209
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MT21204286 Issued in IN
Practice address
5111 N Bend Dr
Fort Wayne, IN 46804-1753
Phone
(260) 436-8807
NPI assigned
Jul 15, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MT21204286 IN Primary

Addresses

Primary practice location

5111 N Bend Dr
Fort Wayne, IN 46804-1753

Mailing address

5111 N Bend Dr
Fort Wayne, IN 46804-1753
Phone (260) 436-8807

Other names 1

  • Ms. Stephanie Clark Former name

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

LicenseStateTypeSpecialty
MT21204286INMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vital Living Therapeutic Massage, LLC Massage Therapist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436918400000",
    "number": "1851775209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5111 N BEND DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041753",
            "telephone_number": "260-436-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5111 N BEND DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041753",
            "telephone_number": "260-436-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLORIN",
        "first_name": "STEPHANIE",
        "name_prefix": "Ms.",
        "credential": "C.M.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "MT21204286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "CLARK",
            "prefix": "MS.",
            "credential": "C.M.T.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; 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.