Active NPI
Jennifer Kathleen Goodermote, LMT
- Massage Therapist
- Jacksonville Beach, FL
National Provider Identifier
1932375698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 18717
- Practice address
- 1105 20TH St N
Jacksonville Beach, FL 32250-2892 - Phone
- (904) 241-4597
- Fax
- (904) 241-4597
- NPI assigned
- May 2, 2008
- 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 | 18717 | FL | Primary |
Addresses
Primary practice location
1105 20TH St N
Jacksonville Beach, FL 32250-2892
Mailing address
1105 20TH St N
Jacksonville Beach, FL 32250-2892
Phone (904) 241-4597
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 |
|---|---|---|---|
| 18717 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209686400000",
"number": "1932375698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1105 20TH ST N",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322502892",
"telephone_number": "904-241-4597",
"fax_number": "904-241-4597"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1105 20TH ST N",
"city": "JACKSONVILLE BEACH",
"state": "FL",
"postal_code": "322502892",
"telephone_number": "904-241-4597",
"fax_number": "904-241-4597"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODERMOTE",
"first_name": "JENNIFER",
"middle_name": "KATHLEEN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-02",
"last_updated": "2008-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "18717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.