Active NPI
Russell Donovan Lord, L.M.T.
- Massage Therapist
- Panama City, FL
National Provider Identifier
1861615650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA-11342
- Practice address
- 449 W 23Rd St
Panama City, FL 32405-4507 - Phone
- (850) 814-7980
- NPI assigned
- Apr 10, 2007
- 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 | MA-11342 | FL | Primary |
Addresses
Primary practice location
449 W 23Rd St
Panama City, FL 32405-4507
Mailing address
PO Box 823
Lynn Haven, FL 32444-0823
Phone (850) 814-7980
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 |
|---|---|---|---|
| MA-11342 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861615650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 823",
"city": "LYNN HAVEN",
"state": "FL",
"postal_code": "324440823",
"telephone_number": "850-814-7980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "449 W 23RD ST",
"city": "PANAMA CITY",
"state": "FL",
"postal_code": "324054507",
"telephone_number": "850-814-7980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORD",
"first_name": "RUSSELL",
"middle_name": "DONOVAN",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA-11342",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Panama City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.