Individual provider Active NPI

Jacqueline Fetter

  • Massage Therapist
  • Longmont, CO
National Provider Identifier
1306660170
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Practice address
630 Coffman St
Longmont, CO 80501-8302
Phone
(303) 652-3533
NPI assigned
Nov 8, 2024
Last updated
Nov 8, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X CO Primary

Addresses

Primary practice location

630 Coffman St
Longmont, CO 80501-8302

Mailing address

736 Wade Rd
Longmont, CO 80503-7018

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

NPI Registry JSON

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

{
    "created_epoch": "1731024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1306660170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "736 WADE RD",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805037018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 COFFMAN ST",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805018302",
            "telephone_number": "303-652-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTER",
        "first_name": "JACQUELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-08",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longmont, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; 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.