MEDICARE: JON ROOT CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	89401	CA

General Provider Information

NPI Number	:	1568359693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON ROOT CMT

Provider Business Mailing Address
First Line	:	68681 PASADA RD
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-4854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 E TAHQUITZ CANYON WAY STE 15
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6712
Country	:	US
Telephone Number	:	310-614-2783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2025
Last Update Date	:	06/20/2025

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Directions to “ JON ROOT CMT” Practice Location

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