NPIMap

Organization Active NPI

Port Jefferson Therapeutic Massage P.C.

  • Massage Therapist
  • Port Jeff Sta, NY
National Provider Identifier
1861156036
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
Legal business name
PORT JEFFERSON THERAPEUTIC MASSAGE P.C.
Practice address
716 Route 112
Port Jeff Sta, NY 11776-1025
Phone
(631) 331-7631
NPI assigned
Oct 25, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Authorized official

Name
Jenifer Kirby, LMT, PTANPI 1619598075
Title
Owner
Phone
(631) 331-7631

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X Primary

Addresses

Primary practice location

716 Route 112
Port Jeff Sta, NY 11776-1025

Mailing address

716 Route 112
Port Jeff Sta, NY 11776-1025
Phone (631) 331-7631

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1861156036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 ROUTE 112",
            "city": "PORT JEFF STA",
            "state": "NY",
            "postal_code": "117761025",
            "telephone_number": "631-331-7631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 ROUTE 112",
            "city": "PORT JEFF STA",
            "state": "NY",
            "postal_code": "117761025",
            "telephone_number": "631-331-7631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT JEFFERSON THERAPEUTIC MASSAGE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "JENIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-331-7631",
        "authorized_official_credential": "LMT, PTA"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jeff Sta, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.