Active NPI
Gary Bolden, R.K.T.
- Kinesiotherapist
- Washington, DC
National Provider Identifier
1033167754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Kinesiotherapist
- License
- 1469
- Practice address
- 25 M St SW
Third Floor (3Rd.) S.W.
Washington, DC 20024-3621 - Phone
- (817) 361-0602
- NPI assigned
- May 5, 2006
- 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 |
|---|---|---|---|---|
| Kinesiotherapist | 226300000X | 1469 | IL | Primary |
Addresses
Primary practice location
25 M St SW
Third Floor (3Rd.) S.W.
Washington, DC 20024-3621
Mailing address
2101 5TH St S
Arlington, VA 22204-1932
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 |
|---|---|---|---|
| 1469 | IL | MD | Kinesiotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192752000000",
"number": "1033167754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2101 5TH ST S",
"city": "ARLINGTON",
"state": "VA",
"postal_code": "222041932"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 M ST SW",
"address_2": "THIRD FLOOR (3RD.) S.W.",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200243621",
"telephone_number": "817-361-0602"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLDEN",
"first_name": "GARY",
"credential": "R.K.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2007-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "226300000X",
"taxonomy_group": "",
"desc": "Kinesiotherapist",
"state": "IL",
"license": "1469",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.