MR. JERRAD LEE BENTON (NPI# 1891211017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891211017 |
| Entity Type | Individual |
| Full Name | MR. JERRAD LEE BENTON |
| Credential | LMT, MMP |
| Practice Address |
2430 Tellicherry Dr Saint Louis MO 63125-3108 |
| Mailing Address |
2430 Tellicherry Dr. 300a Saint Louis MO 63125-3108 |
| Practice Telephone | (314) 600-6293 |
| Mailing Telephone | 3146006293 |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2017-08-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 2001031193 | MO | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
2430 TELLICHERRY DR |
| City | SAINT LOUIS |
| State | MO |
| Zip Code | 63125-3108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396396990 | Linda Marie Monken | Technician | 3792 Southern Manor, St. Louis, MO 63125 | 2019-09-25 |
| 1194373688 | Angel Angelette Rochelle Ellington | Technician | Va St Louis Spinal Cord Injury Unit, 1 Jefferson Barracks Drive 128/jb, St Louis, MO 63125 | 2019-08-28 |
| 1760940209 | Lea-ed Inc | Community Based Residential Treatment Facility, Mental Illness | 30 Sherman Road, Lemay, MO 63125 | 2019-03-04 |
| 1861957185 | Mary M Ross | Occupational Therapist | Sherbrooke Village, 4005 Ripa Ave, St. Louis, MO 63125 | 2019-02-01 |
| 1013400977 | Anne Henry Francis | Dietitian, Registered | Va St. Louis Health Care System, 1 Jefferson Barracks Drive, St. Louis, MO 63125 | 2018-06-14 |
| 1922458660 | Rebecca Mae Waugh | Skilled Nursing Facility | 1001 Holy Grail Ct, Saint Louis, MO 63125 | 2016-06-14 |
| 1942661814 | Dsk Works LLC | Chiropractor | 3193 Lemay Ferry Rd., Saint Louis, MO 63125 | 2016-03-18 |
| 1467717678 | Despine Louise Coulis | Pediatrics | 7545 S Lindbergh Blvd Ste 220, Saint Louis, MO 63125 | 2012-07-13 |
| 1184914194 | Allison Celeste Cassidy | Pharmacist | 3901 Lemay Ferry Road, Saint Louis, MO 63125 | 2011-04-11 |
| 1093049694 | Lauren C Mensie | Psychologist | 1 Jefferson Barracks Dr., 116b/jb St. Louis Va Medical Center, St. Louis, MO 63125 | 2009-09-29 |
| Find all providers in zip 63125 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346848991 | James Allen Brooks | Massage Therapist | 6436 Chippewa St, Saint Louis, MO 63109-2106 | 2020-10-15 |
| 1083220354 | Jennifer Nahmensen | Massage Therapist | 5433 Cherryview Ln, Saint Louis, MO 63128-3729 | 2020-09-21 |
| 1700492147 | Kelly L Reilly | Massage Therapist | 555 N Harrison Ave Apt 2w, Saint Louis, MO 63122-3969 | 2020-09-21 |
| 1205441862 | Blanche Haley | Massage Therapist | 3664 Montana St Fl 1, Saint Louis, MO 63116-4514 | 2020-09-10 |
| 1306450820 | Ana Wooldridge | Massage Therapist | 7241 Saint Andrews Pl, Saint Louis, MO 63121-5028 | 2020-09-02 |
| 1124652391 | Bobby James Wright | Massage Therapist | 1722 Olive St Ste 212, Saint Louis, MO 63103-1700 | 2020-02-26 |
| 1083253520 | Shaka D Mccormick | Massage Therapist | 2804 Osage St, Saint Louis, MO 63118-4537 | 2020-01-01 |
| 1073025763 | Cyretha Ann Staton | Massage Therapist | 2110 Armitage Dr, Saint Louis, MO 63136-6105 | 2017-11-02 |
| 1538605761 | Jamal Carter | Massage Therapist | 12127 Bellefontaine Rd, Suite 16, Saint Louis, MO 63138-1916 | 2017-01-11 |
| 1639537905 | Eric Tillman | Massage Therapist | 8210 Flora Ave, Saint Louis, MO 63114-6202 | 2016-02-02 |
| Find all providers in SAINT LOUIS | ||||
| City | SAINT LOUIS |
| Zip Code | 63125 |
Please comment or provide details below to improve the information on MR. JERRAD LEE BENTON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.