Individual provider Active NPI

Julie L Allen, LMT

  • Massage Therapist
  • Mount Dora, FL
National Provider Identifier
1306190210
Registry record updated Oct 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
MA36704 Issued in FL
Practice address
4400 N Highway 19a # 12
Mount Dora, FL 32757-2032
Phone
(352) 357-5000
NPI assigned
Oct 30, 2012
Sex
Female
Sole proprietor
No

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

LicenseStateTypeSpecialty
MA36704FLMDMassage Therapist

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA36704 FL Primary

Addresses

NPPES NPI Registry

Primary practice location

4400 N Highway 19a # 12
Mount Dora, FL 32757-2032

Mailing address

4400 N Highway 19a # 12
Mount Dora, FL 32757-2032
Phone (352) 357-5000

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
C2690OtherFLFLORIDA BLUE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 30, 2012.

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351555200000",
    "number": "1306190210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 N HIGHWAY 19A # 12",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572032",
            "telephone_number": "352-357-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 N HIGHWAY 19A # 12",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572032",
            "telephone_number": "352-357-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "JULIE",
        "middle_name": "L",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-30",
        "last_updated": "2012-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA36704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "C2690",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Dora, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.

Verify at the official NPI Registry.