Healthcare Provider Details

I. General information

NPI: 1083574669
Provider Name (Legal Business Name): BETTY SAAVEDRA OSPINA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 CAROLINA BEACH RD STE 8
WILMINGTON NC
28412-2760
US

IV. Provider business mailing address

4078 PIGOTT RD SW
SHALLOTTE NC
28470-5585
US

V. Phone/Fax

Practice location:
  • Phone: 404-632-6409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22973
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: