Jillian Mary Beal Ingerson, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT4637 Issued in ME

Practice address

130 Perry Rd
Bangor, ME 04401-6722

Phone

(207) 992-4000

Fax

(207) 558-3285

NPI assigned

Sep 11, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jillian Mary Beal Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Ube Physical Therapy and Performance LLC

  • Physical Therapy Clinic/Center
  • Bangor, ME
  • NPI 1508226119
  NPD

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1104603604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6",
            "city": "STILLWATER",
            "state": "ME",
            "postal_code": "044890006",
            "telephone_number": "207-992-4000",
            "fax_number": "207-558-3285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 PERRY RD",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016722",
            "telephone_number": "207-992-4000",
            "fax_number": "207-558-3285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGERSON",
        "first_name": "JILLIAN",
        "middle_name": "MARY BEAL",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ME",
            "license": "MT4637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JILLIAN",
            "last_name": "BEAL",
            "middle_name": "MARY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Gabrielle Ingerson, PA
• Diana Mary Inkova, CADC
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• Integrated Osteoporosis Clinic
• Invest in You Counseling, LLC
• Peter James Ippoliti, PHD

• All providers in Bangor, ME
• Massage Therapist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; 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.