Palm Beach Massage Therapy, Inc

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

HCC7029 Issued in FL

Legal business name

PALM BEACH MASSAGE THERAPY, INC

Doing business as

Back In Shape Massage Therapy

Practice address

13860 Wellington Trce
Suite #13
Wellington, FL 33414-8588

Phone

(561) 844-6777

Fax

(561) 841-1618

NPI assigned

Sep 24, 2007

Last updated

Sep 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jamie Lynn Konidare

Title

President

Phone

(561) 844-6777

Specialties & licenses 1

Addresses

Other names 1

• Back In Shape Massage Therapy Doing business as

Locations

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

{
    "created_epoch": "1190592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1184810160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "653 FAIRWIND DR",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334084302",
            "telephone_number": "561-844-6777",
            "fax_number": "561-841-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13860 WELLINGTON TRCE",
            "address_2": "SUITE #13",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "334148588",
            "telephone_number": "561-844-6777",
            "fax_number": "561-841-1618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM BEACH MASSAGE THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-24",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "KONIDARE",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-844-6777",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "HCC7029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Back In Shape Massage Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinic/Center in Wellington, FL
• Providers in Wellington, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 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.