NPIMap

Organization Active NPI

New Leaf Physical and Massage Therapy, LLC

  • Physical Medicine & Rehabilitation Physician
  • Portland, OR
National Provider Identifier
1003135658
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
NEW LEAF PHYSICAL AND MASSAGE THERAPY, LLC
Practice address
4050 NE Broadway St
Portland, OR 97232-1828
Phone
(503) 318-0654
NPI assigned
May 21, 2010
Last updated
Jun 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary GramlingNPI 1518925510
Title
President
Phone
(503) 318-0654

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

4050 NE Broadway St
Portland, OR 97232-1828

Mailing address

2734 SE 47TH Ave
Portland, OR 97206-1547
Phone (503) 657-8663

National Provider Directory

National Provider Directory

Locations

4050 NE Broadway St
Portland, OR 97232
Phone (307) 710-4929

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1274400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1003135658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2734 SE 47TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972061547",
            "telephone_number": "503-657-8663",
            "fax_number": "503-723-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321828",
            "telephone_number": "503-318-0654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LEAF PHYSICAL AND MASSAGE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-21",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "GRAMLING",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-318-0654"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.