Active NPI
Brenden Pettingill
- Massage Therapist
- San Francisco, CA
National Provider Identifier
1104690718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 79706
- Practice address
- 4200 18TH St Ste 204
San Francisco, CA 94114-2449 - Phone
- (916) 390-3701
- NPI assigned
- Nov 14, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 | 79706 | CA | Primary |
Addresses
Primary practice location
4200 18TH St Ste 204
San Francisco, CA 94114-2449
Mailing address
1718 14TH St
Oakland, CA 94607-1514
Other practice location 1
1718 14th St
Oakland, CA 94607-1514
Phone (916) 390-3701
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1699920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1699920000000",
"number": "1104690718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1718 14TH ST",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946071514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 18TH ST STE 204",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941142449",
"telephone_number": "916-390-3701"
}
],
"practiceLocations": [
{
"address_1": "1718 14th St",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946071514",
"country_code": "US",
"telephone_number": "916-390-3701",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETTINGILL",
"first_name": "BRENDEN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-14",
"last_updated": "2023-11-14",
"certification_date": "2023-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "79706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.