Active NPI
Trevor Brandon Jackson, MT
- Massage Therapist
- Columbia, SC
National Provider Identifier
1356003552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10033
- Practice address
- 1631 Main St Columbia SC
Columbia, SC 29223 - Phone
- (803) 310-2793
- NPI assigned
- Oct 6, 2021
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 10033 | SC | Primary |
Addresses
Primary practice location
1631 Main St Columbia SC
Columbia, SC 29223
Mailing address
8117 Springflower Road
Columbia, SC 29223
Phone (254) 462-3790
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
- Medical Technician
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10033 | SC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1633478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633478400000",
"number": "1356003552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8117 SPRINGFLOWER ROAD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29223",
"telephone_number": "254-462-3790"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1631 MAIN ST COLUMBIA SC",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "29223",
"telephone_number": "803-310-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "TREVOR",
"middle_name": "BRANDON",
"credential": "MT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-10-06",
"last_updated": "2021-10-06",
"certification_date": "2021-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "SC",
"license": "10033",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.