Kevin Gregory Gardner, MT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

0019012178 Issued in VA

Practice address

4701 Kenmore Ave
Suite 121
Alexandria, VA 22304-2230

Phone

(703) 861-0890

NPI assigned

Feb 28, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Medical Technician

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1582848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582848000000",
    "number": "1265066229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 KENMORE AVE",
            "address_2": "SUITE 121",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223041203",
            "telephone_number": "703-861-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 KENMORE AVE",
            "address_2": "SUITE 121",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223042230",
            "telephone_number": "703-861-0890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4701 Kenmore Ave Apt 121",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "VA",
            "postal_code": "223041203",
            "country_code": "US",
            "telephone_number": "703-861-0890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "KEVIN",
        "middle_name": "GREGORY",
        "credential": "MT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-02-28",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "VA",
            "license": "0019012178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4701",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "massageunique",
            "affiliation": "N",
            "endpointDescription": "SOAP NOTES",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4701 Kenmore Ave",
            "address_2": "Suite 121",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223042230",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Alexandria",
            "affiliation": "N",
            "endpointDescription": "alexandria",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4701 Kenmore Ave",
            "address_2": "Suite 121",
            "city": "Alexandria",
            "state": "VA",
            "country_code": "US",
            "postal_code": "223042230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mariel Ana Garcia
• Paola Garcia
• Polly Jo Garcia, LPC
• Charles William Gardner Jr., M.D.
• Heather Rhodes Gardner
• Rex Clifton Gardner, M.A., PHD
• Getahun Garede
• Keva Garg, M.D.
• Shaila Garg, M.D.
• Jeanine Marie Gargiulo, PA-C

• Massage Therapist in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Massage Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.