Active NPI
Si N/a Chen
- Massage Therapist
- Reston, VA
National Provider Identifier
1417722091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 0019018570
- Practice address
- 11703 Bowman Green Dr
Suite 100
Reston, VA 20190 - Phone
- (571) 325-9393
- NPI assigned
- Nov 23, 2023
- Sex
- Male
- Sole proprietor
- No
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 | 0019018570 | VA | Primary |
Addresses
Primary practice location
11703 Bowman Green Dr
Suite 100
Reston, VA 20190
Mailing address
11663 Charter Oak CT Apt 202
Reston, VA 20190-4534
Phone (571) 314-6251
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 |
|---|---|---|---|
| 0019018570 | VA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1700697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705017600000",
"number": "1417722091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11663 CHARTER OAK CT APT 202",
"city": "RESTON",
"state": "VA",
"postal_code": "201904534",
"telephone_number": "571-314-6251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11703 BOWMAN GREEN DR",
"address_2": "SUITE 100",
"city": "RESTON",
"state": "VA",
"postal_code": "20190",
"telephone_number": "571-325-9393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHEN",
"first_name": "SI",
"middle_name": "N/A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-23",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "VA",
"license": "0019018570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.