Active NPI
Michelle Boller, CMT
- Massage Therapist
- San Diego, CA
National Provider Identifier
1003429408
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 29634
- Practice address
- 813 W Washington St
San Diego, CA 92103-1804 - Phone
- (619) 269-9909
- NPI assigned
- Aug 25, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 29634 | CA | Primary |
Addresses
Primary practice location
813 W Washington St
San Diego, CA 92103-1804
Mailing address
3009 Union St Unit 2
San Diego, CA 92103-6080
Phone (917) 710-1325
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 |
|---|---|---|---|
| 29634 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Casey Chiropractic Inc. | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598313600000",
"number": "1003429408",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3009 UNION ST UNIT 2",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921036080",
"telephone_number": "917-710-1325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "813 W WASHINGTON ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921031804",
"telephone_number": "619-269-9909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLLER",
"first_name": "MICHELLE",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-25",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "29634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.