Healthcare Provider Details

I. General information

NPI: 1922939743
Provider Name (Legal Business Name): KEVIN WHELAN CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

IV. Provider business mailing address

317 N EL CAMINO REAL STE 306
ENCINITAS CA
92024-2814
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-4400
  • Fax: 858-673-4499
Mailing address:
  • Phone: 858-673-4400
  • Fax: 858-673-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: