Active NPI
Angela Jean Davis, LMT
- Massage Therapist
- Tigard, OR
National Provider Identifier
1043345267
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 11689
- Practice address
- 18039 SW Lower Boones Ferry Rd
Tigard, OR 97224-7228 - Phone
- (503) 481-4945
- NPI assigned
- Feb 21, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 11689 | OR | Primary |
Addresses
Primary practice location
18039 SW Lower Boones Ferry Rd
Tigard, OR 97224-7228
Mailing address
9025 SW Oak St
Tigard, OR 97223-6547
Phone (503) 481-4945
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11689 | OR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043345267",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9025 SW OAK ST",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236547",
"telephone_number": "503-481-4945"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18039 SW LOWER BOONES FERRY RD",
"city": "TIGARD",
"state": "OR",
"postal_code": "972247228",
"telephone_number": "503-481-4945"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "ANGELA",
"middle_name": "JEAN",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "11689",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.