Active NPI
Gregory William Jolly, L.M.T.
- Massage Therapist
- Wauwatosa, WI
National Provider Identifier
1821339847
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 821-146
- Practice address
- 8320 W Bluemound Rd
Wauwatosa, WI 53213-3367 - Phone
- (414) 302-3800
- NPI assigned
- Mar 15, 2013
- Sex
- Male
- Sole proprietor
- No
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 | 821-146 | WI | Primary |
Addresses
Primary practice location
8320 W Bluemound Rd
Wauwatosa, WI 53213-3367
Mailing address
5653 N Stanton Dr
Glendale, WI 53209-4357
Phone (414) 238-3229
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 |
|---|---|---|---|
| 821-146 | WI | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363305600000",
"number": "1821339847",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5653 N STANTON DR",
"city": "GLENDALE",
"state": "WI",
"postal_code": "532094357",
"telephone_number": "414-238-3229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8320 W BLUEMOUND RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532133367",
"telephone_number": "414-302-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLY",
"first_name": "GREGORY",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-03-15",
"last_updated": "2013-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WI",
"license": "821-146",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.