Active NPI
Theresa Y Jackson, LMT
- Massage Therapist
- Jacksonville, FL
National Provider Identifier
1841486289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA48068
- Practice address
- 1803 Boulevard
Jacksonville, FL 32206-4342 - Phone
- (904) 236-4619
- Fax
- (904) 236-6187
- NPI assigned
- Sep 19, 2007
- Sex
- Female
- 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 | MA48068 | FL | Primary |
Addresses
Primary practice location
1803 Boulevard
Jacksonville, FL 32206-4342
Mailing address
1803 Boulevard
Jacksonville, FL 32206-4342
Phone (904) 766-1484
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 |
|---|---|---|---|
| MA48068 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiro-Med Plus | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Jacksonville, FL
- NPI 1659402667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190160000000",
"number": "1841486289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1803 BOULEVARD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322064342",
"telephone_number": "904-766-1484",
"fax_number": "904-236-6187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1803 BOULEVARD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322064342",
"telephone_number": "904-236-4619",
"fax_number": "904-236-6187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "THERESA",
"middle_name": "Y",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-09-19",
"last_updated": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA48068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.