Jeremy M Dellosa, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT-16774 Issued in AZ

Practice address

8200 E Jacque Dr
Prescott Valley, AZ 86314-6172

Phone

(928) 277-8715

NPI assigned

Dec 3, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Presscott Pain Center LLC

  • Chiropractor
  • Prescott Valley, AZ
  • NPI 1083557243

  Massage Therapist

  NPD (past)

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606953600000",
    "number": "1255936688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6279 N MOONLIGHT WAY",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863143352",
            "telephone_number": "602-733-3743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8200 E JACQUE DR",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863146172",
            "telephone_number": "928-277-8715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELLOSA",
        "first_name": "JEREMY",
        "middle_name": "M",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "AZ",
            "license": "MT-16774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Mechelle Davis, LMT
• Mark B Davis, D.O.
• George E. Dean, M. D.
• Linda Degner, LIMHP, LPC
• Darryl A Dehart, RPH
• Ann M Delorme, LPC
• Joseph Demichele, RN
• Starr W Denison, MS, LPC
• Sean P Derry, LPC
• Krishna H Desai

• Massage Therapist in Prescott Valley, AZ
• Providers in Prescott Valley, AZ by specialty
• Massage Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.