Medsports Promassage

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

MA36322 Issued in FL

Legal business name

MEDSPORTS PROMASSAGE

Practice address

3491 Pall Mall Dr
Suite 104
Jacksonville, FL 32257-5449

Phone

(904) 505-0575

NPI assigned

Apr 2, 2012

Last updated

Apr 2, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Monique Coleman Hamid, LMT

Title

Owner

Phone

(904) 505-0575

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Monique Coleman-Harris, LMT

  • Massage Therapist
  • Jacksonville, FL
  • NPI 1669652228
  NPD (past)

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1932475167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8565",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320060014",
            "telephone_number": "904-505-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3491 PALL MALL DR",
            "address_2": "SUITE 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322575449",
            "telephone_number": "904-505-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSPORTS PROMASSAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-02",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "HAMID",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "COLEMAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-505-0575",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "FL",
            "license": "MA36322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Medina, M.D.
• Richard Hiwatig Medina, DNP
• Saul Medina
• Tracie Drinkwater Medina, APRN
• Sherri Lorraine Medious-Jordan
• Medstar Clinic LLC
• Jillian Kimberly Medure, D.M.D
• Andrew Medvedovsky, MD
• Steven Medvid, M.D.
• Medvidi Health, P.a.

• Preferred Provider Organization in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Preferred Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; 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.