GARY MITCHELL VAN DERVEER LMT NPI 1528639960

NPI Information

NPI: 1528639960
Provider Name: GARY MITCHELL VAN DERVEER, LMT
Classification: Massage Therapist - 225700000X
Entity Type: Individual
Address:
3935 E GREENWAY RD APT 205
PHOENIX, AZ
ZIP 85032
Phone: (602) 497-7422
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Gary Mitchell Van Derveer, LMT is a massage therapist in Phoenix, AZ. 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. Gary Mitchell Van Derveer, LMT NPI is 1528639960. The provider is registered as an individual entity type and is a single specialty group.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3935 E GREENWAY RD APT 205
PHOENIX, AZ
ZIP 85032-671
Phone: (602) 497-7422

The enumeration date for this NPI number is 7/7/2021 and was last updated on 7/7/2021.

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		MT-14602	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MT-14602	OTHER	ARIZONA	AZ STATE MASSAGE BOARD

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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