Active NPI
Walter Gerrard Nivens
- Massage Therapist
- Simpsonville, SC
National Provider Identifier
1720798671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 6830
- Practice address
- 819 McKinney Rd
Simpsonville, SC 29681-4605 - Phone
- (864) 553-8290
- NPI assigned
- Dec 1, 2022
- Sex
- Male
- Sole proprietor
- No
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 | 6830 | SC | Primary |
Addresses
Primary practice location
819 McKinney Rd
Simpsonville, SC 29681-4605
Mailing address
819 McKinney Rd
Simpsonville, SC 29681-4605
Phone (864) 553-8290
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 |
|---|---|---|---|
| 6830 | SC | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1669852800000",
"number": "1720798671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "819 MCKINNEY RD",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296814605",
"telephone_number": "864-553-8290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "819 MCKINNEY RD",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296814605",
"telephone_number": "864-553-8290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIVENS",
"first_name": "WALTER",
"middle_name": "GERRARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-12-01",
"last_updated": "2022-12-01",
"certification_date": "2022-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "SC",
"license": "6830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.