Active NPI
Malissa M Bordelon, LMT
- Massage Therapist
- Long Beach, MS
National Provider Identifier
1619264157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 1861
- Practice address
- 7198 Beatline Rd
Suite a
Long Beach, MS 39560-9146 - Phone
- (228) 868-9799
- NPI assigned
- Jul 5, 2011
- Last updated
- Jul 5, 2011
- 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 | 1861 | MS | Primary |
Addresses
Primary practice location
7198 Beatline Rd
Suite a
Long Beach, MS 39560-9146
Mailing address
PO Box 8864
Gulfport, MS 39506-8864
Phone (228) 223-7400
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 |
|---|---|---|---|
| 1861 | MS | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309824000000",
"number": "1619264157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8864",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395068864",
"telephone_number": "228-223-7400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7198 BEATLINE RD",
"address_2": "SUITE A",
"city": "LONG BEACH",
"state": "MS",
"postal_code": "395609146",
"telephone_number": "228-868-9799"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORDELON",
"first_name": "MALISSA",
"middle_name": "M",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-05",
"last_updated": "2011-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MS",
"license": "1861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.