Active NPI
Larissa Jae Taylor, LMT
- Massage Therapist
- Mesa, AZ
National Provider Identifier
1154150415
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT-24487
- Practice address
- 4111 E Valley Auto Dr Ste 209
Mesa, AZ 85206-4609 - Phone
- (480) 401-7495
- NPI assigned
- Jul 26, 2024
- 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 | MT-24487 | AZ | Primary |
Addresses
Primary practice location
4111 E Valley Auto Dr Ste 209
Mesa, AZ 85206-4609
Mailing address
1511 E Moon Vista St
Apache Junction, AZ 85119-9632
Phone (480) 401-7495
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-24487 | AZ | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1154150415",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1511 E MOON VISTA ST",
"city": "APACHE JUNCTION",
"state": "AZ",
"postal_code": "851199632",
"telephone_number": "480-401-7495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4111 E VALLEY AUTO DR STE 209",
"city": "MESA",
"state": "AZ",
"postal_code": "852064609",
"telephone_number": "480-401-7495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAYLOR",
"first_name": "LARISSA",
"middle_name": "JAE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-26",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "AZ",
"license": "MT-24487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.