MRS. SUSAN M. GOLMAN LMT, MMP, NPI 1104161991 — PICAYUNE (MS)

NPI 1104161991

7+ Years Experience Individual

MRS. SUSAN M. GOLMAN LMT, MMP

12.05.2012
PROVIDER ENUMERATION DATE
12.05.2012
LAST UPDATE DATE
1104161991
NPI NUMBER

About MRS. SUSAN M. GOLMAN

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

MRS. SUSAN M. GOLMAN is a provider established in PICAYUNE, MS. The NPI number of MRS. SUSAN M. GOLMAN is 1104161991 and was assigned on 12.05.2012. The practitioners primary taxonomy code is: 225700000X with license number: LMT 1214 MS .

Mailing address

  • City: PICAYUNE
  • State: MS
  • Postal code: 394663110
  • Phone: 5047173467
  • Address: 1616 W FOURTH AVE

Primary Practice Address

  • Region : PICAYUNE, MS
  • NPI : 1104161991
  • Phone : 5047173467
  • Postalcode : 394663948
  • Address : 401 WILLIAMS AVE

Provider taxonomy - Massage Therapist

  • Taxonomy code: 225700000X
  • License number: LMT 1214
  • License state: MS

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

Healthcare provider taxonomy #2 - Massage Therapist

  • Taxonomy code: 225700000X
  • License number: LA 4325
  • License state: LA

The taxonomy is not the primary taxonomy.

Taxonomy description: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

Contacts:

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  • MRS. SUSAN M. GOLMAN LMT, MMP
  • Address : 401 WILLIAMS AVE
  • Region : PICAYUNE, MS
  • NPI : 1104161991
  • Phone : 5047173467
  • Postalcode : 394663948

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address401 WILLIAMS AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePICAYUNE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMS
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code394663948
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number5047173467
The telephone number associated with the location address of the provider being identified.
NPI1104161991
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1225700000X
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
Provider Enumeration Date12.05.2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated12.05.2012
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)MRS. SUSAN M. GOLMAN
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address1616 W FOURTH AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Business Mailing Address City NamePICAYUNE
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMS
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code394663110
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number5047173467
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #1225700000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Massage Therapist
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
Provider License Number 1LMT 1214
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MS
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 2225700000X
Healthcare Provider Taxonomy 2Massage Therapist
An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.
Provider License Number 2LA 4325
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2LA
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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