Mida Lila-Marie Kelleher, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA47456 Issued in FL

Practice address

2208 Woodbury Rd
Melbourne, FL 32935-3059

Phone

(321) 302-4860

NPI assigned

Mar 26, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104944511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2208 WOODBURY RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353059",
            "telephone_number": "321-302-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2208 WOODBURY RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353059",
            "telephone_number": "321-302-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEHER",
        "first_name": "MIDA",
        "middle_name": "LILA-MARIE",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA47456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Douglas Kearney, M.D.
• Jarrod D Kearney, PA
• Michael A Kearney
• Mark A Kedzierski, D.D.S.
• Sandra Ogata Keefe, M.D.
• Paul M Keller, MD
• Stone William Keller
• Cori Devon Kellner, ARNP, WHNP-BC
• Krista Janine Delaney Kello, AU.D.
• Kelly L Dunn MD PA

• Massage Therapist in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.