Active NPI
Petcharin Mathison
- Massage Therapist
- Simi Valley, CA
National Provider Identifier
1184056699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 45575
- Practice address
- 5956 E Los Angeles Ave Ste 4
Simi Valley, CA 93063-4369 - Phone
- (805) 522-5552
- NPI assigned
- Aug 7, 2013
- Last updated
- Aug 7, 2013
- Sex
- Female
- 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 | 45575 | CA | Primary |
Addresses
Primary practice location
5956 E Los Angeles Ave Ste 4
Simi Valley, CA 93063-4369
Mailing address
5956 E Los Angeles Ave Ste 4
Simi Valley, CA 93063-4369
Phone (805) 522-5552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 45575 | Other | CA | MASSAGE PRACTITIONER |
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 |
|---|---|---|---|
| 45575 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1375833600000",
"number": "1184056699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5956 E LOS ANGELES AVE STE 4",
"city": "SIMI VALLEY",
"state": "CA",
"postal_code": "930634369",
"telephone_number": "805-522-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5956 E LOS ANGELES AVE STE 4",
"city": "SIMI VALLEY",
"state": "CA",
"postal_code": "930634369",
"telephone_number": "805-522-5552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATHISON",
"first_name": "PETCHARIN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-08-07",
"last_updated": "2013-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "45575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSAGE PRACTITIONER",
"identifier": "45575",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Simi Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.