NPIMap

Organization Active NPI

Massage Revolution

  • Massage Therapist
  • Jackson, MS
National Provider Identifier
1104253285
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
2027 Issued in MS
Legal business name
MASSAGE REVOLUTION
Practice address
210 E Capitol St
Suite M-142
Jackson, MS 39201-2306
Phone
(601) 918-1853
NPI assigned
Oct 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

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

Authorized official

Name
Mr. Abraham Santa Cruz
Title
Operations Manager
Phone
(601) 918-1853

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X 2027 MS Primary

Addresses

Primary practice location

210 E Capitol St
Suite M-142
Jackson, MS 39201-2306

Mailing address

210 E Capitol St
Suite M-142
Jackson, MS 39201-2306
Phone (601) 918-1853

Other names 1

  • Massage Revolution, LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Massage Revolution2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1104253285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E CAPITOL ST",
            "address_2": "SUITE M-142",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392012306",
            "telephone_number": "601-918-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 E CAPITOL ST",
            "address_2": "SUITE M-142",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392012306",
            "telephone_number": "601-918-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAGE REVOLUTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "SANTA CRUZ",
        "authorized_official_first_name": "ABRAHAM",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "601-918-1853",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "MS",
            "license": "2027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massage Revolution, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.