Active NPI
Brian James Petrich, LMT
- Massage Therapist
- Port Orchard, WA
National Provider Identifier
1003470154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA60936482
- Practice address
- 1963 Bethel Rd SE
Port Orchard, WA 98366-3108 - Phone
- (253) 861-5297
- NPI assigned
- Apr 24, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA60936482 | WA | Primary |
Addresses
Primary practice location
1963 Bethel Rd SE
Port Orchard, WA 98366-3108
Mailing address
15769 Sunny Cove Dr SE
Olalla, WA 98359-9594
Phone (253) 861-5297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA60936482 | WA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556064000000",
"number": "1003470154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15769 SUNNY COVE DR SE",
"city": "OLALLA",
"state": "WA",
"postal_code": "983599594",
"telephone_number": "253-861-5297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1963 BETHEL RD SE",
"city": "PORT ORCHARD",
"state": "WA",
"postal_code": "983663108",
"telephone_number": "253-861-5297"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRICH",
"first_name": "BRIAN",
"middle_name": "JAMES",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-24",
"last_updated": "2019-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WA",
"license": "MA60936482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orchard, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.