Greg Anderson, MASSAGE THERAPIST

Individual provider Active NPI Massage Therapist · Los Ranchos, NM

NPI 1346724689 · NPPES record last updated Sep 22, 2018

Key facts

NPI
1346724689
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
S-0553 (NM)
Practice address
6855 4TH St NW Ste B-2
Los Ranchos, NM 87107-6100
Phone
(505) 508-2752
NPI assigned
Sep 22, 2018
Sex
Male
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
S-0553NMMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
GC Ventures and Co. Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X S-0553 NM Yes

Addresses

Primary practice location

6855 4TH St NW Ste B-2
Los Ranchos, NM 87107-6100

Mailing address

397 Buffalo Cir SE
Albuquerque, NM 87123-3524
Phone (505) 489-3903

Other providers in Los Ranchos, NM

All providers in Los Ranchos, NM · Massage Therapist in New Mexico

Sources for this page

Verify at the official NPI Registry.