Active NPI
Samuel Derossett
- Massage Therapist
- New Haven, MI
National Provider Identifier
1295414126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501012056
- Practice address
- 37681 Sandstone TRL
New Haven, MI 48048-3729 - Phone
- (618) 319-0945
- NPI assigned
- Jul 17, 2023
- Last updated
- Jul 17, 2023
- 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 | 7501012056 | MI | Primary |
Addresses
Primary practice location
37681 Sandstone TRL
New Haven, MI 48048-3729
Mailing address
37681 Sandstone TRL
New Haven, MI 48048-3729
Phone (618) 319-0945
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 |
|---|---|---|---|
| 7501012056 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689552000000",
"number": "1295414126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37681 SANDSTONE TRL",
"city": "NEW HAVEN",
"state": "MI",
"postal_code": "480483729",
"telephone_number": "618-319-0945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37681 SANDSTONE TRL",
"city": "NEW HAVEN",
"state": "MI",
"postal_code": "480483729",
"telephone_number": "618-319-0945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROSSETT",
"first_name": "SAMUEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-17",
"last_updated": "2023-07-17",
"certification_date": "2023-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501012056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, MI
- Jennifer Boileau
- Joshua Braden
- Dannette Brown, MA, LLPC
- Erika Ann Brown, DLLP LPC NCC CCTP
- Aaron William Cloutier, D.O
- David Dickson
- Marcella Dooley
- Downriver Community Services Inc (DCS Pharmacy - New Haven)
- Downriver Community Services, Inc. (Community First Health Centers)
- Downriver Community Services, Inc. (Community First Health Centers)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.