Blue Water Medical Massage PLLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501006219 Issued in MI

Legal business name

BLUE WATER MEDICAL MASSAGE PLLC

Practice address

1221 Briarwood Dr
Port Huron, MI 48060-2092

Phone

(810) 488-0787

Fax

(810) 294-5356

NPI assigned

Mar 29, 2018

Organization subpart

No

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

Authorized official

Name

Joshua Allen ColeNPI 1245607233

Title

Owner

Phone

(810) 488-0787

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua Allen Cole

  • Massage Therapist
  • Port Huron, MI
  • NPI 1245607233
  NPD Authorized official

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

{
    "created_epoch": "1522281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522281600000",
    "number": "1790280899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 BRIARWOOD DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480602092",
            "telephone_number": "810-488-0787",
            "fax_number": "810-294-5356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 BRIARWOOD DR",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480602092",
            "telephone_number": "810-488-0787",
            "fax_number": "810-294-5356"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER MEDICAL MASSAGE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-29",
        "last_updated": "2018-03-29",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-488-0787"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501006219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; 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.