Coralie Jenner, CMT, LMT, HHP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

74620 Issued in CA

Practice address

418 Aviation Blvd Ste D
Santa Rosa, CA 95403-1074

Phone

(707) 486-9846

NPI assigned

Nov 6, 2016

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Massage for Athletes, Inc.

  • Massage Therapist
  • Santa Rosa, CA
  • NPI 1750955381

  Health Educator

  NPD Authorized official

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

{
    "created_epoch": "1478390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1962944157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 MAXWELL ST",
            "city": "HEALDSBURG",
            "state": "CA",
            "postal_code": "954483533",
            "telephone_number": "707-486-9846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 AVIATION BLVD STE D",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954031074",
            "telephone_number": "707-486-9846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENNER",
        "first_name": "CORALIE",
        "credential": "CMT, LMT, HHP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-06",
        "last_updated": "2021-05-18",
        "certification_date": "2020-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "74620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jada Jeffries, ASW
• Vanessa Renee Jellison
• Richard Stephen Jenderseck, D.D.S,
• Jennifer Jenkins, MA
• Sarah Faith Jenkins
• Jennifer Blum PSYD Licensed Psychologist PC
• Jennifer Nguyen Hubert, D.O., Inc
• Jennifer Yang Psychologist P.C.
• Krista Shea Jennings
• Erica Jennison, PHYSICAL THERAPIST

• Massage Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.