Brandon Boutain

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA61007858 Issued in WA

Practice address

12121 E Broadway Ave Ste 5B
Spokane Valley, WA 99206-4972

Phone

(509) 921-9800

Fax

(509) 921-9810

NPI assigned

Nov 2, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572652800000",
    "number": "1982248928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12121 E BROADWAY AVE STE 5B",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992064972",
            "telephone_number": "509-921-9800",
            "fax_number": "509-921-9800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12121 E BROADWAY AVE STE 5B",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992064972",
            "telephone_number": "509-921-9800",
            "fax_number": "509-921-9810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22622 E Coronado Ct",
            "address_purpose": "LOCATION",
            "city": "Otis Orchards",
            "state": "WA",
            "postal_code": "990279302",
            "country_code": "US",
            "telephone_number": "509-631-0053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUTAIN",
        "first_name": "BRANDON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-02",
        "last_updated": "2019-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA61007858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sophia Bosse, RD, CD
• Aubrey Jean Bot
• Kathryn Bough, PHARMACY TECHNICIAN
• Helaina Yvonne Stanyer Boulieris, O.D.
• George James Bourekis, DDS
• Omari Elizabeth Rose Boutain
• Dallon Bowen
• Kristina Bowen, M.D.
• Brittney Nicole Boyd, LMP
• Debra Lynn Bradford

• Massage Therapist in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.