Active NPI
Jepthe Soulouque, MS LAT ATC
- Athletic Trainer
- West Roxbury, MA
National Provider Identifier
1306446489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 30544
- Practice address
- 235 Baker St
West Roxbury, MA 02132-4395 - Phone
- (617) 469-8055
- NPI assigned
- Oct 28, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 30544 | MA | Primary |
Addresses
Primary practice location
235 Baker St
West Roxbury, MA 02132-4395
Mailing address
48 Cross St
Everett, MA 02149-1820
Phone (617) 913-6113
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30544 | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603843200000",
"number": "1306446489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "48 CROSS ST",
"city": "EVERETT",
"state": "MA",
"postal_code": "021491820",
"telephone_number": "617-913-6113"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "235 BAKER ST",
"city": "WEST ROXBURY",
"state": "MA",
"postal_code": "021324395",
"telephone_number": "617-469-8055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOULOUQUE",
"first_name": "JEPTHE",
"credential": "MS LAT ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-10-28",
"last_updated": "2020-10-28",
"certification_date": "2020-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "30544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.