Active NPI
Jennifer Massimino
- Pediatric Physical Therapist
- Saint Louis, MO
National Provider Identifier
1649840711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 118744
- Practice address
- 801 N 11TH St
Saint Louis, MO 63101-1015 - Phone
- (314) 633-5300
- NPI assigned
- Jun 30, 2021
- 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 |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 118744 | MO | Primary |
Addresses
Primary practice location
801 N 11TH St
Saint Louis, MO 63101-1015
Mailing address
12856 Haw Thicket LN
Saint Louis, MO 63131-2132
Phone (314) 821-1953
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 |
|---|---|---|---|
| 118744 | MO | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730937600000",
"number": "1649840711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12856 HAW THICKET LN",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631312132",
"telephone_number": "314-821-1953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 N 11TH ST",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631011015",
"telephone_number": "314-633-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASSIMINO",
"first_name": "JENNIFER",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-30",
"last_updated": "2024-11-07",
"certification_date": "2024-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "MO",
"license": "118744",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.