Active NPI
Jeremy Daniel Powell
- Massage Therapist
- Southfield, MI
National Provider Identifier
1780308056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 7501014893
- Practice address
- 23105 Providence Dr Apt 316
Southfield, MI 48075-3653 - Phone
- (805) 940-7153
- NPI assigned
- Sep 30, 2022
- Last updated
- Sep 30, 2022
- Sex
- Male
- 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 | 7501014893 | MI | Primary |
Addresses
Primary practice location
23105 Providence Dr Apt 316
Southfield, MI 48075-3653
Mailing address
23105 Providence Dr Apt 316
Southfield, MI 48075-3653
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 |
|---|---|---|---|
| 7501014893 | MI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664496000000",
"number": "1780308056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23105 PROVIDENCE DR APT 316",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480753653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23105 PROVIDENCE DR APT 316",
"city": "SOUTHFIELD",
"state": "MI",
"postal_code": "480753653",
"telephone_number": "805-940-7153"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POWELL",
"first_name": "JEREMY",
"middle_name": "DANIEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-30",
"last_updated": "2022-09-30",
"certification_date": "2022-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MI",
"license": "7501014893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.