Active NPI
Charles Wilson Evans, MASSAGE THERAPIST
- Massage Therapist
- Phoenix, AZ
National Provider Identifier
1952964769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT-23677
- Practice address
- 14828 N 32ND Dr
Phoenix, AZ 85053-4703 - Phone
- (623) 226-2156
- NPI assigned
- Apr 17, 2019
- Sex
- Male
- 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 | MT-23677 | AZ | Primary |
Addresses
Primary practice location
14828 N 32ND Dr
Phoenix, AZ 85053-4703
Mailing address
14828 N 32ND Dr
Phoenix, AZ 85053-4703
Phone (623) 226-2156
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 |
|---|---|---|---|
| MT-23677 | AZ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555459200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1952964769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14828 N 32ND DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850534703",
"telephone_number": "623-226-2156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14828 N 32ND DR",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850534703",
"telephone_number": "623-226-2156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "CHARLES",
"middle_name": "WILSON",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-17",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "MT-23677",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.