Active NPI
Jacqueline Collette Johnson, LMT, NTS
- Massage Therapist
- Albuquerque, NM
National Provider Identifier
1609433804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 9685
- Practice address
- 612 Madeira Dr SE
Albuquerque, NM 87108-3614 - Phone
- (505) 263-7882
- NPI assigned
- May 22, 2019
- 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 | 9685 | NM | Primary |
Addresses
Primary practice location
612 Madeira Dr SE
Albuquerque, NM 87108-3614
Mailing address
612 Madeira Dr SE
Albuquerque, NM 87108-3614
Phone (505) 263-7882
Other practice location 1
425 University Blvd NE
Albuquerque, NM 87106-4556
Phone (505) 263-7882
Other practice location 2
9204 Menaul Blvd NE Ste 4
Albuquerque, NM 87112-2201
Phone (505) 883-1212
Other names 1
- Jacqueline Collette Paytiamo
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 |
|---|---|---|---|
| 9685 | NM | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ocean Blue Medical Massage and Spa LLC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Massage Therapist
- Albuquerque, NM
- NPI 1821537226
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1558483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558483200000",
"number": "1609433804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 MADEIRA DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871083614",
"telephone_number": "505-263-7882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 MADEIRA DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871083614",
"telephone_number": "505-263-7882"
}
],
"practiceLocations": [
{
"address_1": "425 University Blvd NE",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871064556",
"country_code": "US",
"telephone_number": "505-263-7882",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9204 Menaul Blvd NE Ste 4",
"address_purpose": "LOCATION",
"city": "Albuquerque",
"state": "NM",
"postal_code": "871122201",
"country_code": "US",
"telephone_number": "505-883-1212",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACQUELINE",
"middle_name": "COLLETTE",
"credential": "LMT, NTS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-05-22",
"last_updated": "2019-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NM",
"license": "9685",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JACQUELINE",
"last_name": "PAYTIAMO",
"middle_name": "COLLETTE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.