Brenna Dwyer

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

LMT-LMT-LIC-10017 Issued in MT

Practice address

702 W Main St
Bozeman, MT 59715-3357

Phone

(406) 586-3390

NPI assigned

Jul 18, 2019

Sex

Female

Sole proprietor

Yes

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

Practice roles

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.

• Black Dog Performance, LLC

  • Massage Therapist
  • Bozeman, MT
  • NPI 1588396675

  Single Specialty

  NPD Authorized official

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

{
    "created_epoch": "1563408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563408000000",
    "number": "1568015642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10261",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597190261",
            "telephone_number": "425-686-4349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 W MAIN ST",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153357",
            "telephone_number": "406-586-3390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "169 Snowy Mountain Circle",
            "address_purpose": "LOCATION",
            "city": "Big Sky",
            "state": "MT",
            "postal_code": "597165971",
            "country_code": "US",
            "telephone_number": "406-993-2510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DWYER",
        "first_name": "BRENNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-18",
        "last_updated": "2019-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "MT",
            "license": "LMT-LMT-LIC-10017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eduardo F Duran, PSYCHOLOGIST
• Morgan Durbin, LMSW
• Teresa Dutro
• Dutton & Willhite, Inc.
• Daniel Dutton, D.C.
• Deanna Dykema, NNP-BC
• Eagle Mount - Bozeman
• Kelly Earle, DNP, APRN, FNC-C
• Eating Disorder Center of Montana
• Eating Disorder Center of Montana

• Massage Therapist in Bozeman, MT
• Providers in Bozeman, MT by specialty
• Massage Therapist in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2019; 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.