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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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
1	225700000X	Massage Therapist		30211	CALIFORNIA	Yes

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: 4/28/2024

NPI Synchronization or Removal

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