RUSS ODOM CMT CMMP NPI 1104172253

NPI Information

  • NPI: 1104172253
  • Provider Name: RUSS ODOM, CMT, CMMP
  • Classification: Massage Therapist - 225700000X
  • Entity Type: Individual
  • Address: 2128 CRENSHAW ST
    SAN DIEGO, CA
    ZIP 92105
  • Phone: (619) 339-1306

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NPI Details

Russ Odom, CMT, CMMP is a massage therapist in San Diego, CA. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. Russ Odom, CMT, CMMP NPI is 1104172253. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2128 CRENSHAW ST
SAN DIEGO, CA
ZIP 92105-130
Phone: (619) 339-1306

The enumeration date for this NPI number is 7/26/2012 and was last updated on 7/26/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1225700000XMassage Therapist30211CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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