Active NPI
Maria Jean Waltz, LMT
- Massage Therapist
- Godfrey, IL
National Provider Identifier
1740694025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 227.006520
- Practice address
- 1316 Dadrian Professional Park
Godfrey, IL 62035-1685 - Phone
- (618) 467-0300
- Fax
- (618) 467-4065
- NPI assigned
- Jun 16, 2014
- 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 | 227.006520 | IL | Primary |
Addresses
Primary practice location
1316 Dadrian Professional Park
Godfrey, IL 62035-1685
Mailing address
1316 Dadrian Professional Park
Godfrey, IL 62035-1685
Phone (618) 467-0300
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 |
|---|---|---|---|
| 227.006520 | IL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1740694025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1316 DADRIAN PROFESSIONAL PARK",
"city": "GODFREY",
"state": "IL",
"postal_code": "620351685",
"telephone_number": "618-467-0300",
"fax_number": "618-467-4065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1316 DADRIAN PROFESSIONAL PARK",
"city": "GODFREY",
"state": "IL",
"postal_code": "620351685",
"telephone_number": "618-467-0300",
"fax_number": "618-467-4065"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "MARIA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IL",
"license": "227.006520",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Godfrey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.