Active NPI
Tracy Dawn Vanwoert, MASSAGE THERAPIST
- Massage Therapist
- Jackson, MI
National Provider Identifier
1104224187
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501004489
- Practice address
- 215 S Dettman Rd
Jackson, MI 49203-2204 - Phone
- (517) 788-5443
- NPI assigned
- Dec 8, 2014
- 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 | 7501004489 | MI | Primary |
Addresses
Primary practice location
215 S Dettman Rd
Jackson, MI 49203-2204
Mailing address
913 Longfellow Ave
Jackson, MI 49202-3033
Phone (517) 499-8336
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 |
|---|---|---|---|
| 7501004489 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736467200000",
"number": "1104224187",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "913 LONGFELLOW AVE",
"city": "JACKSON",
"state": "MI",
"postal_code": "492023033",
"telephone_number": "517-499-8336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 S DETTMAN RD",
"city": "JACKSON",
"state": "MI",
"postal_code": "492032204",
"telephone_number": "517-788-5443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANWOERT",
"first_name": "TRACY",
"middle_name": "DAWN",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-12-08",
"last_updated": "2025-01-10",
"certification_date": "2025-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501004489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.