Active NPI
Johnie M. Kelly Jr., CACMT
- Massage Therapist
- Los Altos, CA
National Provider Identifier
1043809023
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 1148
- Practice address
- 895 Sherwood Ave Ste 101
Los Altos, CA 94022-1344 - Phone
- (650) 810-6582
- NPI assigned
- Jan 13, 2021
- Sex
- Male
- 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 | 1148 | CA | Primary |
Addresses
Primary practice location
895 Sherwood Ave Ste 101
Los Altos, CA 94022-1344
Mailing address
171 Hamilton Ave
Mountain View, CA 94043-4204
Phone (650) 810-6582
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 |
|---|---|---|---|
| 1148 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1610496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610496000000",
"number": "1043809023",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 HAMILTON AVE",
"city": "MOUNTAIN VIEW",
"state": "CA",
"postal_code": "940434204",
"telephone_number": "650-810-6582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "895 SHERWOOD AVE STE 101",
"city": "LOS ALTOS",
"state": "CA",
"postal_code": "940221344",
"telephone_number": "650-810-6582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JOHNIE",
"middle_name": "M.",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "CACMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-13",
"last_updated": "2021-01-13",
"certification_date": "2021-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "1148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Altos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.