Active NPI
Melissa Lorraine Wynn, CMT
- Massage Therapist
- San Jose, CA
National Provider Identifier
1154102424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 73052
- Practice address
- 1449 Shortridge Ave
San Jose, CA 95116-2351 - Phone
- (408) 608-7909
- NPI assigned
- Oct 11, 2023
- Sex
- Female
- 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 | 73052 | CA | Primary |
Addresses
Primary practice location
1449 Shortridge Ave
San Jose, CA 95116-2351
Mailing address
PO Box 720591
San Jose, CA 95172-0591
Phone (408) 608-7909
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 |
|---|---|---|---|
| 73052 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696982400000",
"number": "1154102424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 720591",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951720591",
"telephone_number": "408-608-7909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1449 SHORTRIDGE AVE",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951162351",
"telephone_number": "408-608-7909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "MELISSA",
"middle_name": "LORRAINE",
"name_prefix": "Ms.",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-11",
"last_updated": "2023-10-11",
"certification_date": "2023-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "73052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.