Active NPI
William S Allen Jr., LMT
- Massage Therapist
- Orange Park, FL
National Provider Identifier
1104669704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 100828
- Practice address
- 179 College Dr Ste 16
Orange Park, FL 32065-7690 - Phone
- (352) 283-5864
- NPI assigned
- Jun 13, 2024
- 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 | 100828 | FL | Primary |
Addresses
Primary practice location
179 College Dr Ste 16
Orange Park, FL 32065-7690
Mailing address
5005 Spearmint St
Middleburg, FL 32068-5953
Phone (352) 283-5864
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 |
|---|---|---|---|
| 100828 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718236800000",
"number": "1104669704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5005 SPEARMINT ST",
"city": "MIDDLEBURG",
"state": "FL",
"postal_code": "320685953",
"telephone_number": "352-283-5864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "179 COLLEGE DR STE 16",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320657690",
"telephone_number": "352-283-5864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "WILLIAM",
"middle_name": "S",
"name_suffix": "Jr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-06-13",
"last_updated": "2024-06-13",
"certification_date": "2024-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "FL",
"license": "100828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.