Active NPI
Kathleen S Gallardo, LMT
- Massage Therapist
- Fort Walton Beach, FL
National Provider Identifier
1679783468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MA42983
- Practice address
- 306 Perry Ave SE
Fort Walton Beach, FL 32548-5848 - Phone
- (850) 864-0800
- NPI assigned
- May 23, 2007
- Last updated
- Jun 6, 2013
- 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 | MA42983 | FL | Primary |
Addresses
Primary practice location
306 Perry Ave SE
Fort Walton Beach, FL 32548-5848
Mailing address
2584 Weeping Willow LN
Navarre, FL 32566-2450
Phone (850) 454-9132
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 |
|---|---|---|---|
| MA42983 | FL | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370476800000",
"number": "1679783468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2584 WEEPING WILLOW LN",
"city": "NAVARRE",
"state": "FL",
"postal_code": "325662450",
"telephone_number": "850-454-9132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 PERRY AVE SE",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325485848",
"telephone_number": "850-864-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLARDO",
"first_name": "KATHLEEN",
"middle_name": "S",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-23",
"last_updated": "2013-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "FL",
"license": "MA42983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.