Active NPI
Matthew Weston Graham, LMT
- Massage Therapist
- San Pedro, CA
National Provider Identifier
1669247235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 22809
- Practice address
- 2209 W 25TH St Unit 1
San Pedro, CA 90732-4147 - Phone
- (310) 345-5569
- Fax
- (310) 935-7992
- NPI assigned
- Nov 23, 2023
- 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 | 22809 | CA | Primary |
Addresses
Primary practice location
2209 W 25TH St Unit 1
San Pedro, CA 90732-4147
Mailing address
2209 W 25TH St Unit 1
San Pedro, CA 90732-4147
Phone (310) 345-5569
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22809 | Other | CA | CALIFORNIA MASSAGE THERAPY COUNCIL |
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 |
|---|---|---|---|
| 22809 | CA | MD | Occupational 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": "1701043200000",
"number": "1669247235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2209 W 25TH ST UNIT 1",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907324147",
"telephone_number": "310-345-5569",
"fax_number": "310-935-7992"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2209 W 25TH ST UNIT 1",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907324147",
"telephone_number": "310-345-5569",
"fax_number": "310-935-7992"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "MATTHEW",
"middle_name": "WESTON",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-23",
"last_updated": "2023-11-27",
"certification_date": "2023-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "CA",
"license": "22809",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA MASSAGE THERAPY COUNCIL",
"identifier": "22809",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.