Active NPI
Omari Banner
- Massage Therapist
- Waltham, MA
National Provider Identifier
1861312175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17561
- Practice address
- 49 Ravenswood Rd
Waltham, MA 02453-1747 - Phone
- (781) 547-1713
- NPI assigned
- Jul 16, 2026
- 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 | 17561 | MA | Primary |
Addresses
Primary practice location
49 Ravenswood Rd
Waltham, MA 02453-1747
Mailing address
49 Ravenswood Rd
Waltham, MA 02453-1747
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784160000000",
"number": "1861312175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "49 RAVENSWOOD RD",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024531747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 RAVENSWOOD RD",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024531747",
"telephone_number": "781-547-1713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNER",
"first_name": "OMARI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-16",
"last_updated": "2026-07-16",
"certification_date": "2026-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MA",
"license": "17561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.