Provider Demographics
NPI:1790663870
Name:MASSAGE BY JADE PLLC
Entity type:Organization
Organization Name:MASSAGE BY JADE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORIJADE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA72330
Authorized Official - Phone:561-567-2054
Mailing Address - Street 1:4535 LUCERNE LAKES BLVD W APT 107
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8936
Mailing Address - Country:US
Mailing Address - Phone:561-567-2054
Mailing Address - Fax:
Practice Address - Street 1:4535 LUCERNE LAKES BLVD W APT 107
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-8936
Practice Address - Country:US
Practice Address - Phone:561-567-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty