Active NPI
Shanee Kiera Buckner, CMT
- Massage Therapist
- Los Angeles, CA
National Provider Identifier
1518705334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 73398
- Practice address
- 4340 Beverly Blvd
Los Angeles, CA 90004-4444 - Phone
- (213) 474-6109
- NPI assigned
- Jul 16, 2024
- Sex
- Female
- 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 | 73398 | CA | Primary |
Addresses
Primary practice location
4340 Beverly Blvd
Los Angeles, CA 90004-4444
Mailing address
4340 Beverly Blvd
Los Angeles, CA 90004-4444
Phone (213) 474-6109
Other names 1
- Revival Routine
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)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721088000000",
"number": "1518705334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4340 BEVERLY BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900044444",
"telephone_number": "213-474-6109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4340 BEVERLY BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900044444",
"telephone_number": "213-474-6109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKNER",
"first_name": "SHANEE",
"middle_name": "KIERA",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-16",
"last_updated": "2024-07-16",
"certification_date": "2024-07-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "73398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "REVIVAL",
"last_name": "ROUTINE",
"credential": "CMT",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.