Active NPI
Jordan Potts, MT
- Massage Therapist
- Lihue, HI
National Provider Identifier
1598305195
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12999
- Practice address
- 3-1866 Kaumualii Hwy
Lihue, HI 96766-8606 - Phone
- (808) 333-3688
- NPI assigned
- Jan 10, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 | 12999 | HI | Primary |
Addresses
Primary practice location
3-1866 Kaumualii Hwy
Lihue, HI 96766-8606
Mailing address
6330 Makana Rd
Kapaa, HI 96746-9483
Phone (719) 207-2103
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 |
|---|---|---|---|
| 12999 | HI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578614400000",
"number": "1598305195",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6330 MAKANA RD",
"city": "KAPAA",
"state": "HI",
"postal_code": "967469483",
"telephone_number": "719-207-2103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3-1866 KAUMUALII HWY",
"city": "LIHUE",
"state": "HI",
"postal_code": "967668606",
"telephone_number": "808-333-3688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTS",
"first_name": "JORDAN",
"credential": "MT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-01-10",
"last_updated": "2020-01-10",
"certification_date": "2020-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "HI",
"license": "12999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lihue, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.