Active NPI
Mavis Baker
- Massage Therapist
- Jacksonville, FL
National Provider Identifier
1649667148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA#69139
- Practice address
- 11740-2 San Jose Blvd
Jacksonville, FL 32223-1629 - Phone
- (904) 880-5755
- NPI assigned
- Apr 22, 2015
- 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 | MA#69139 | FL | Primary |
Addresses
Primary practice location
11740-2 San Jose Blvd
Jacksonville, FL 32223-1629
Mailing address
12074 Coachman Meadows Dr
Jacksonville, FL 32246-0559
Phone (904) 553-1103
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 |
|---|---|---|---|
| MA#69139 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429660800000",
"number": "1649667148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12074 COACHMAN MEADOWS DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322460559",
"telephone_number": "904-553-1103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11740-2 SAN JOSE BLVD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322231629",
"telephone_number": "904-880-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAKER",
"first_name": "MAVIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-04-22",
"last_updated": "2015-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA#69139",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.