Active NPI
Gregge Forrest Stewart, LMT
- Massage Therapist
- Port Orange, FL
National Provider Identifier
1700042504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA15529
- Practice address
- 3959 S Nova Rd Ste 35B
Port Orange, FL 32127-9229 - Phone
- (407) 613-6815
- NPI assigned
- Jul 31, 2008
- Sex
- Male
- Sole proprietor
- No
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 | MA15529 | FL | Primary |
Addresses
Primary practice location
3959 S Nova Rd Ste 35B
Port Orange, FL 32127-9229
Mailing address
202 Loquat LN
Port Orange, FL 32127-4837
Phone (407) 613-6815
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 |
|---|---|---|---|
| MA15529 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Injury Rehab Specialists | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1700042504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 LOQUAT LN",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321274837",
"telephone_number": "407-613-6815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3959 S NOVA RD STE 35B",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321279229",
"telephone_number": "407-613-6815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEWART",
"first_name": "GREGGE",
"middle_name": "FORREST",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-31",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA15529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.