Active NPI
Jennifer Ellis, LMT
- Massage Therapist
- Monticello, FL
National Provider Identifier
1851683775
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA30673
- Practice address
- 180 S Cherry St
Suite F
Monticello, FL 32344-1929 - Phone
- (850) 694-2204
- Fax
- (850) 997-4483
- NPI assigned
- May 11, 2011
- Last updated
- May 11, 2011
- Sex
- Female
- 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 | MA30673 | FL | Primary |
Addresses
Primary practice location
180 S Cherry St
Suite F
Monticello, FL 32344-1929
Mailing address
425 Cedar St
Monticello, FL 32344-1529
Phone (850) 694-2204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C9973 | Other | FL | BCBS OF FL |
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 |
|---|---|---|---|
| MA30673 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305072000000",
"number": "1851683775",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 CEDAR ST",
"city": "MONTICELLO",
"state": "FL",
"postal_code": "323441529",
"telephone_number": "850-694-2204",
"fax_number": "850-997-4483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 S CHERRY ST",
"address_2": "SUITE F",
"city": "MONTICELLO",
"state": "FL",
"postal_code": "323441929",
"telephone_number": "850-694-2204",
"fax_number": "850-997-4483"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JENNIFER",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-11",
"last_updated": "2011-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA30673",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF FL",
"identifier": "C9973",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Monticello, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.