Active NPI
Jeremy Porter
- Massage Therapist
- Mishawaka, IN
National Provider Identifier
1104730860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT22608995
- Practice address
- 229 Red Coach Dr Ste 107
Mishawaka, IN 46545-3195 - Phone
- (574) 318-7800
- NPI assigned
- Sep 30, 2026
- Last updated
- Sep 30, 2026
- 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 | MT22608995 | IN | Primary |
Addresses
Primary practice location
229 Red Coach Dr Ste 107
Mishawaka, IN 46545-3195
Mailing address
21649 Maple Glen Dr
Edwardsburg, MI 49112-9718
Phone (303) 587-4893
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790726400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790726400000",
"number": "1104730860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21649 MAPLE GLEN DR",
"city": "EDWARDSBURG",
"state": "MI",
"postal_code": "491129718",
"telephone_number": "303-587-4893"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 RED COACH DR STE 107",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465453195",
"telephone_number": "574-318-7800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JEREMY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-09-30",
"last_updated": "2026-09-30",
"certification_date": "2026-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT22608995",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.