Active NPI
Jillyn Wall, LMT
- Massage Therapist
- Colorado Springs, CO
National Provider Identifier
1003330945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT122402
- Practice address
- 1495 Garden of the Gods Rd # 10
Colorado Springs, CO 80907-9441 - Phone
- (719) 260-9797
- NPI assigned
- Aug 2, 2017
- Sex
- Female
- 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 | MT122402 | TX | Primary |
Addresses
Primary practice location
1495 Garden of the Gods Rd # 10
Colorado Springs, CO 80907-9441
Mailing address
1495 Garden of the Gods Rd # 10
Colorado Springs, CO 80907-9441
Phone (719) 260-9797
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 |
|---|---|---|---|
| MT122402 | TX | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1003330945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1495 GARDEN OF THE GODS RD # 10",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809079441",
"telephone_number": "719-260-9797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1495 GARDEN OF THE GODS RD # 10",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809079441",
"telephone_number": "719-260-9797"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "JILLYN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-08-02",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "TX",
"license": "MT122402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.