Jason Christopher Moore, LMT
Individual provider Active NPI Massage Therapist · Paonia, CO
NPI 1114689502 · NPPES record last updated Oct 12, 2021
Key facts
- NPI
- 1114689502
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 24361 (CO)
- Practice address
- 41050 Lamborn Mesa Rd
Paonia, CO 81428-6433 - Phone
- (267) 670-9535
- NPI assigned
- Oct 12, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24361 | CO | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 24361 | CO | Yes |
Addresses
Primary practice location
41050 Lamborn Mesa Rd
Paonia, CO 81428-6433
Mailing address
41050 Lamborn Mesa Rd
Paonia, CO 81428-6433
Phone (267) 670-9535
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24361 | Other | CO | DEPARTMENT OF REGULATORY AGENCIES - COLORADO |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | Paonia | Health Information Exchange (HIE) |
Other providers in Paonia, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.