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Deactivated NPI 1396937330 Deactivated / Inactive NPI Male Practitioner

Jon R Petersen , LMT

Massage Therapist • Mchenry, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jon Petersen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 14, 2007
NPI Deactivation Date July 03, 2025
Total Practice Duration ~18 Years of Practice (2007 – 2025)

Professional Overview & Biography Verified Profile Summary

Jon Petersen, LMT was a registered Massage Therapist practicing in Mchenry, IL. Throughout an active medical career spanning 18 years, Jon Petersen provided care at the practice location at 1307 COURT ST until profile deactivation on 2025-07-03.

Practice Location & Contact Primary Location

Practice Address

1307 Court St

Mchenry, IL 600504422

Telephone 8153858190
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Massage Therapist in Mchenry, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 10.2 Yrs
Regional Practice Density
10 Specialists

Practicing in Mchenry, IL (1467 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Massage Therapist Primary Specialty

NUCC Taxonomy Code: 225700000X

State License IL 227-000243

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.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated July 03, 2025

Record deactivated on July 03, 2025

NPI Profile Active May 10, 2010

NPI status registered as active in NPPES database

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Updated Practice Location May 10, 2010

Registered at 1307 COURT ST, MCHENRY, IL 600504422 (Tel: 8153858190)

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Updated Business Mailing Address May 10, 2010

Registered at 1307 COURT ST, MCHENRY, IL 600504422 (Tel: 8153858190)

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Provider Name / Credentials Updated May 10, 2010

Recorded as JON PETERSEN, L.M.T.

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 10, 2010

Massage Therapist (License #227-000243 in IL)

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Initial NPI Registration & Enumeration August 14, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1396937330
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 14, 2007
Last Update: May 10, 2010
Deactivation Date: July 03, 2025

Mailing Address

1307 Court St

Mchenry, IL 600504422

Phone: 8153858190

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.