Mountain State Medical Massage

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

MOUNTAIN STATE MEDICAL MASSAGE

Practice address

6970 S Holly Cir
Centennial, CO 80112-6296

Phone

(720) 841-1042

NPI assigned

Aug 19, 2022

Organization subpart

No

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

Authorized official

Name

Jenny M Nickerson, LMT

Title

Owner

Phone

(720) 841-1042

Specialties & licenses 1

Addresses

Other names 1

• Mountain State Medical Massage Former legal business name

Tax ID family

Jenny Nickerson2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Jenny Nickerson

  • Massage Therapist
  • Centennial, CO
  • NPI 1437857679
  NPD tax ID

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

{
    "created_epoch": "1660867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674000000000",
    "number": "1558089904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4767 S ODESSA ST",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "800153449",
            "telephone_number": "720-841-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6970 S HOLLY CIR",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801126296",
            "telephone_number": "720-841-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN STATE MEDICAL MASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-19",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "JENNY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-841-1042",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain State Medical Massage",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mountain State Medical Massage",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Mountain State Medical Massage",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Jennifer M Mote
• Jennifer Motley
• Kelsey Nicole Motley
• Mountain Sage Massage, LLC
• Mountain Smiles - Christiansen Dental, PLLC
• Mountain View Eyecare LLC
• Mountain Wellness PLLC
• Mountaintop Acupuncture, LLC
• Michelle Moyn
• Amaris Mozon

• Massage Therapist in Centennial, CO
• Providers in Centennial, CO by specialty
• Massage Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; 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.