Space Coast Massage Therapy Inc.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MM3853 Issued in FL

Legal business name

SPACE COAST MASSAGE THERAPY INC.

Practice address

1070 S Wickham Rd
West Melbourne, FL 32904-1653

Phone

(321) 729-9000

Fax

(321) 722-3997

NPI assigned

Feb 27, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jody Stork I, LMT

Title

Proprietor

Phone

(321) 729-9000

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740317635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1070 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329041653",
            "telephone_number": "321-729-9000",
            "fax_number": "321-722-3997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1070 S WICKHAM RD",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329041653",
            "telephone_number": "321-729-9000",
            "fax_number": "321-722-3997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST MASSAGE THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STORK",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "321-729-9000",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MM3853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.