Active NPI
Traci Lynn Derr, HHP, CMT
- Massage Therapist
- Santee, CA
National Provider Identifier
1669847448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 61672
- Practice address
- 8528 N Magnolia Ave Ste 102
Santee, CA 92071-4692 - Phone
- (619) 972-8650
- NPI assigned
- Dec 5, 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 | 61672 | CA | Primary |
Addresses
Primary practice location
8528 N Magnolia Ave Ste 102
Santee, CA 92071-4692
Mailing address
8528 N Magnolia Ave Ste 102
Santee, CA 92071-4692
Phone (619) 972-8650
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 |
|---|---|---|---|
| 61672 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1449273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632182400000",
"number": "1669847448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8528 N MAGNOLIA AVE STE 102",
"city": "SANTEE",
"state": "CA",
"postal_code": "920714692",
"telephone_number": "619-972-8650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8528 N MAGNOLIA AVE STE 102",
"city": "SANTEE",
"state": "CA",
"postal_code": "920714692",
"telephone_number": "619-972-8650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERR",
"first_name": "TRACI",
"middle_name": "LYNN",
"name_prefix": "Miss",
"credential": "HHP, CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-12-05",
"last_updated": "2021-09-21",
"certification_date": "2021-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "61672",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santee, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.