Active NPI
Jeremy Dickerson, LMT
- Massage Therapist
- Milford, DE
National Provider Identifier
1114469202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT-0004366
- Practice address
- 5995 Williamsville Rd
Milford, DE 19963-6314 - Phone
- (302) 503-2580
- NPI assigned
- Nov 7, 2016
- Last updated
- Nov 7, 2016
- 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 | MT-0004366 | DE | Primary |
Addresses
Primary practice location
5995 Williamsville Rd
Milford, DE 19963-6314
Mailing address
5995 Williamsville Rd
Milford, DE 19963-6314
Phone (302) 503-2580
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 |
|---|---|---|---|
| MT-0004366 | DE | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478476800000",
"number": "1114469202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5995 WILLIAMSVILLE RD",
"city": "MILFORD",
"state": "DE",
"postal_code": "199636314",
"telephone_number": "302-503-2580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5995 WILLIAMSVILLE RD",
"city": "MILFORD",
"state": "DE",
"postal_code": "199636314",
"telephone_number": "302-503-2580"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKERSON",
"first_name": "JEREMY",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-07",
"last_updated": "2016-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "DE",
"license": "MT-0004366",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milford, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.