Active NPI
Jacqueline Diane Nitka, LMT
- Massage Therapist
- Rochester, NY
National Provider Identifier
1225255912
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 015390
- Practice address
- 625 Panorama TRL
BLDG 1
Rochester, NY 14625-2404 - Phone
- (585) 586-7630
- Fax
- (585) 586-7695
- NPI assigned
- Apr 20, 2007
- 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 | 015390 | NY | Primary |
Addresses
Primary practice location
625 Panorama TRL
BLDG 1
Rochester, NY 14625-2404
Mailing address
625 Panorama TRL
BLDG 1
Rochester, NY 14625-2404
Phone (585) 586-7630
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 |
|---|---|---|---|
| 015390 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1225255912",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 PANORAMA TRL",
"address_2": "BLDG 1",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146252404",
"telephone_number": "585-586-7630",
"fax_number": "585-586-7695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 PANORAMA TRL",
"address_2": "BLDG 1",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146252404",
"telephone_number": "585-586-7630",
"fax_number": "585-586-7695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NITKA",
"first_name": "JACQUELINE",
"middle_name": "DIANE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "015390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.