Active NPI
Lawrence Jertberg, L.M.T.
- Massage Therapist
- Alachua, FL
National Provider Identifier
1245581404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA62326
- Practice address
- 16824 NW 174TH Ter
Alachua, FL 32615-4731 - Phone
- (386) 569-7801
- Fax
- (386) 462-4062
- NPI assigned
- Sep 27, 2012
- Sex
- Male
- 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 | MA62326 | FL | Primary |
Addresses
Primary practice location
16824 NW 174TH Ter
Alachua, FL 32615-4731
Mailing address
16824 NW 174TH Ter
Alachua, FL 32615-4731
Phone (386) 569-7801
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 |
|---|---|---|---|
| MA62326 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348704000000",
"number": "1245581404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16824 NW 174TH TER",
"city": "ALACHUA",
"state": "FL",
"postal_code": "326154731",
"telephone_number": "386-569-7801",
"fax_number": "386-462-4062"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16824 NW 174TH TER",
"city": "ALACHUA",
"state": "FL",
"postal_code": "326154731",
"telephone_number": "386-569-7801",
"fax_number": "386-462-4062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JERTBERG",
"first_name": "LAWRENCE",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-09-27",
"last_updated": "2012-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA62326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alachua, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.