Active NPI
Jacqueline Petty
- Massage Therapist
- Chesterfield, MO
National Provider Identifier
1508670449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 2008017099
- Practice address
- 42 Four Seasons Shopping Ctr Ste 111
Chesterfield, MO 63017-3197 - Phone
- (314) 884-0411
- NPI assigned
- Feb 3, 2025
- Sex
- Female
- 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 | 2008017099 | MO | Primary |
Addresses
Primary practice location
42 Four Seasons Shopping Ctr Ste 111
Chesterfield, MO 63017-3197
Mailing address
896 Emerald Place Dr
Saint Charles, MO 63304-1091
Phone (314) 808-5639
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 |
|---|---|---|---|
| 2008017099 | MO | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1738540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738540800000",
"number": "1508670449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "896 EMERALD PLACE DR",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633041091",
"telephone_number": "314-808-5639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 FOUR SEASONS SHOPPING CTR STE 111",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630173197",
"telephone_number": "314-884-0411"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "JACQUELINE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-03",
"last_updated": "2025-02-03",
"certification_date": "2025-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MO",
"license": "2008017099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chesterfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.