Benjamin Edward Brodie, CMT, NMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

75327 Issued in CA

Practice address

10990 Warner Ave Ste B
Fountain Valley, CA 92708-3849

Phone

(714) 593-8881

NPI assigned

Oct 9, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1539043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1467927186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17284 NEWHOPE ST STE 217",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927088201",
            "telephone_number": "951-486-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10990 WARNER AVE STE B",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083849",
            "telephone_number": "714-593-8881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17284 Newhope St Ste 217",
            "address_purpose": "LOCATION",
            "city": "Fountain Valley",
            "state": "CA",
            "postal_code": "927088201",
            "country_code": "US",
            "telephone_number": "951-486-1796",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODIE",
        "first_name": "BENJAMIN",
        "middle_name": "EDWARD",
        "credential": "CMT, NMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-09",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "75327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; 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.