Active NPI
Walter Raymond Selens, L.M.T.
- Massage Therapist
- Portland, ME
National Provider Identifier
1366579955
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT1104
- Practice address
- 500 Forest Ave.
2ND Floor
Portland, ME 04101 - Phone
- (207) 838-4394
- Fax
- (207) 878-3314
- NPI assigned
- Feb 28, 2007
- 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 | MT1104 | ME | Primary |
Addresses
Primary practice location
500 Forest Ave.
2ND Floor
Portland, ME 04101
Mailing address
500 Forest Ave
2ND Floor
Portland, ME 04101
Phone (207) 838-4394
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100191 | Other | ME | ANTHEM BLUE CROSS |
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 |
|---|---|---|---|
| MT1104 | ME | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343088000000",
"number": "1366579955",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 FOREST AVE",
"address_2": "2ND FLOOR",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04101",
"telephone_number": "207-838-4394",
"fax_number": "207-878-3314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 FOREST AVE.",
"address_2": "2ND FLOOR",
"city": "PORTLAND",
"state": "ME",
"postal_code": "04101",
"telephone_number": "207-838-4394",
"fax_number": "207-878-3314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELENS",
"first_name": "WALTER",
"middle_name": "RAYMOND",
"name_prefix": "Mr.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2012-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "ME",
"license": "MT1104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE CROSS",
"identifier": "100191",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.