Shane Wilding Nall, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA88028 Issued in FL

Practice address

14985 Old Saint Augustine Rd Unit 106
Jacksonville, FL 32258-9478

Phone

(904) 288-9491

Fax

(904) 288-9698

NPI assigned

Mar 30, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Jacksonville Orthopaedic Institute Inc

  • Orthopaedic Surgery Physician
  • Jacksonville, FL
  • NPI 1346298023

  Massage Therapist

  NPD (past)
• Jacksonville Orthopaedic Institute Inc

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1346399698

  Massage Therapist

  NPD (past)
• Jacksonville Orthopaedic Institute Inc

  • Physical Therapist
  • Jacksonville Beach, FL
  • NPI 1902954332
  NPD (past)

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

{
    "created_epoch": "1522368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1912402934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14985 OLD SAINT AUGUSTINE RD UNIT 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589478",
            "telephone_number": "904-288-9491",
            "fax_number": "904-288-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14985 OLD SAINT AUGUSTINE RD UNIT 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322589478",
            "telephone_number": "904-288-9491",
            "fax_number": "904-288-9698"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1577 Roberts Dr Ste 320",
            "address_purpose": "LOCATION",
            "city": "Jacksonville Beach",
            "state": "FL",
            "postal_code": "322503266",
            "country_code": "US",
            "telephone_number": "904-247-3324",
            "fax_number": "904-247-3926",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1325 San Marco Blvd Ste 102",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322078549",
            "country_code": "US",
            "telephone_number": "904-858-7045",
            "fax_number": "904-858-7047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NALL",
        "first_name": "SHANE",
        "middle_name": "WILDING",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-30",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA88028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.