Carl Hedges III
Individual provider Active NPI Massage Therapist · Overton, TX
NPI 1962859835 · NPPES record last updated May 19, 2016
Key facts
- NPI
- 1962859835
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT123783 (TX)
- Practice address
- 412 1/2 N Warren St
Overton, TX 75684-1116 - Phone
- (903) 808-5568
- NPI assigned
- May 19, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT123783 | TX | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT123783 | TX | Yes |
Addresses
Primary practice location
412 1/2 N Warren St
Overton, TX 75684-1116
Mailing address
412 1/2 N Warren St
Overton, TX 75684-1116
Phone (903) 808-5568
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MT123783 | Other | TX | MASSAGE THERAPY |
Other providers in Overton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.