Active NPI
Brian Gwaltney, CMT
- Massage Therapist
- Roseville, CA
National Provider Identifier
1669894663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 50701
- Practice address
- 305 C St Apt B
Roseville, CA 95678-3170 - Phone
- (907) 764-9014
- NPI assigned
- Jan 9, 2014
- 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 | 50701 | CA | Primary |
Addresses
Primary practice location
305 C St Apt B
Roseville, CA 95678-3170
Mailing address
305 C St Apt B
Roseville, CA 95678-3170
Phone (907) 764-9014
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 |
|---|---|---|---|
| 50701 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389225600000",
"number": "1669894663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 C ST APT B",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956783170",
"telephone_number": "907-764-9014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 C ST APT B",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956783170",
"telephone_number": "907-764-9014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GWALTNEY",
"first_name": "BRIAN",
"credential": "CMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-09",
"last_updated": "2014-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "CA",
"license": "50701",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.