Jaclyn Davis, PTA, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

227007638 Issued in IL

Practice address

932 N Wright St Ste 160
Naperville, IL 60563-3601

Phone

(630) 508-0223

NPI assigned

Aug 14, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Jaclyn Latart Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1376438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694304000000",
    "number": "1851724744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 N BROADVIEW AVE",
            "city": "LOMBARD",
            "state": "IL",
            "postal_code": "601481521",
            "telephone_number": "630-508-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "932 N WRIGHT ST STE 160",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605633601",
            "telephone_number": "630-508-0223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17W775 Butterfield Rd Ste 128",
            "address_purpose": "LOCATION",
            "city": "Oakbrook Terrace",
            "state": "IL",
            "postal_code": "601814535",
            "country_code": "US",
            "telephone_number": "630-508-0223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JACLYN",
        "credential": "PTA, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-14",
        "last_updated": "2023-09-10",
        "certification_date": "2023-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.006497",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "60668567",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227007638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "LATART",
            "credential": "PTA, LMT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ann Renee Davis, MD
• Benjamin H Davis, DPT
• Cecilia N. Davis, LCPC
• Chelsea Davis, PTA
• Cierra Davis
• James R Davis, MD
• Kimberly Davis, MSTOM, L.AC
• Makayla Davis
• Richard M Davis, PA-C
• Sandra Lynn Davis, APN-CNP

• Massage Therapist in Naperville, IL
• Providers in Naperville, IL by specialty
• Massage Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2023; 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.