MEDICARE: MR. GREGORY BERNARD ATKINS MT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	72751	CA

General Provider Information

NPI Number	:	1770368219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY BERNARD ATKINS MT

Provider Business Mailing Address
First Line	:	6545 SIMPSON AVE APT 15
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2446
Country	:	US
Telephone Number	:	818-877-3373
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 SIMPSON AVE APT 15
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2446
Country	:	US
Telephone Number	:	818-877-3373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2023
Last Update Date	:	08/31/2023

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