Jerrell S Bostick, B.S.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT135450 Issued in TX

Practice address

504 Railway St
Daytona Beach, FL 32114-2654

Phone

(386) 679-8532

NPI assigned

Aug 11, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705104000000",
    "number": "1003163858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 RAILWAY ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142654",
            "telephone_number": "386-679-8532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 RAILWAY ST",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142654",
            "telephone_number": "386-679-8532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTICK",
        "first_name": "JERRELL",
        "middle_name": "S",
        "credential": "B.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-08-11",
        "last_updated": "2024-01-13",
        "certification_date": "2024-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TX",
            "license": "MT135450",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA79474",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremy Booms, CRNA
• Laura Michelle Booth, RMHCI
• Jessica N Boquet
• Rose Boscaino, ARNP
• Davida Bostic
• Rasha Botros, FNP
• Salma Bouchibti
• Traci C Boullion, AGNP-C
• Reginald Bowden, MD
• Dina Bitar Bowen, FNP-BC

• Massage Therapist in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.