Gary Peloquin, LMT

Primary specialty

ReflexologistTaxonomy code 173C00000X

License

MA23030 Issued in FL

Practice address

1830 NE Dixie Hwy
Jensen Beach, FL 34957-6445

Phone

(772) 225-5555

Fax

(772) 225-0675

NPI assigned

Aug 15, 2009

Sex

Male

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 15, 2009.

{
    "created_epoch": "1250294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250294400000",
    "number": "1528290145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 NE DIXIE HWY",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349576445",
            "telephone_number": "772-225-5555",
            "fax_number": "772-225-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 NE DIXIE HWY",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349576445",
            "telephone_number": "772-225-5555",
            "fax_number": "772-225-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELOQUIN",
        "first_name": "GARY",
        "name_prefix": "Mr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-08-15",
        "last_updated": "2009-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "173C00000X",
            "taxonomy_group": "",
            "desc": "Reflexologist",
            "state": "FL",
            "license": "MA23030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MASSAGE THERAPY LICENSE",
            "identifier": "MA23030",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jensen Beach, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2009; 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.