Active NPI
Jason P Kelly, LMT
- Massage Therapist
- North Syracuse, NY
National Provider Identifier
1811452378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 021332-1
- Practice address
- 709 N Main St
North Syracuse, NY 13212-1669 - Phone
- (315) 459-4549
- NPI assigned
- Feb 8, 2019
- 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 | 021332-1 | NY | Primary |
Addresses
Primary practice location
709 N Main St
North Syracuse, NY 13212-1669
Mailing address
709 N Main St
North Syracuse, NY 13212-1669
Phone (315) 459-4549
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9286674 | Other | NY | VA PROGRAM |
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 |
|---|---|---|---|
| 021332-1 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549584000000",
"number": "1811452378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 N MAIN ST",
"city": "NORTH SYRACUSE",
"state": "NY",
"postal_code": "132121669",
"telephone_number": "315-459-4549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 N MAIN ST",
"city": "NORTH SYRACUSE",
"state": "NY",
"postal_code": "132121669",
"telephone_number": "315-459-4549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "JASON",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-08",
"last_updated": "2019-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "021332-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA PROGRAM",
"identifier": "9286674",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Syracuse, NY
- Juan L. Sotomayor, M.D., P.C. (Allergy & Asthma Diagnostic Office)
- Dylan L Juda, PA
- Brian Defreest Katt, LMT
- Suchitra Kavety, M.D.
- Deirdre Keenan, RPA-C
- Kristen Marie Kelsen, PHYSICAL THERAPIST
- Mikala Lynn Kirkby
- Kirsten P Magowan MD PC (Northcourt Pediatrics)
- Nina Kishova
- Katie Ashley Klee, RN, BSN, FNP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.