John Julius Gerideau III, LMT, MLD

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

9586 Issued in SC

Practice address

151 Waterloo St SW
Aiken, SC 29801-3756

Phone

(877) 462-1827

NPI assigned

Dec 14, 2023

Last updated

Dec 14, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1285402776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "708 DAVIS TER NW",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298014036",
            "telephone_number": "877-462-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 WATERLOO ST SW",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298013756",
            "telephone_number": "877-462-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERIDEAU",
        "first_name": "JOHN",
        "middle_name": "JULIUS",
        "name_suffix": "III",
        "credential": "LMT, MLD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-14",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "SC",
            "license": "9586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• David H Gibbs, MD
• Tiffany Gibbs

• Massage Therapist in Aiken, SC
• Providers in Aiken, SC by specialty
• Massage Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2023; 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.