NPIMap

Organization Active NPI

Element Wellness and Sports Rehabilitation

  • Massage Therapist
  • Portland, OR
National Provider Identifier
1043694433
Registry record updated Jul 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
21383 Issued in OR
Legal business name
ELEMENT WELLNESS AND SPORTS REHABILITATION
Practice address
5331 SW Macadam Ave Ste 105
Portland, OR 97239-3848
Phone
(503) 445-7999
Fax
(503) 445-7997
NPI assigned
Jul 15, 2015
Last updated
Jul 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2015

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

Authorized official

Name
Enoch Wilson, LMT
Title
Massage Therapist
Phone
(503) 445-7999

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X 21383 OR Primary

Addresses

Primary practice location

5331 SW Macadam Ave Ste 105
Portland, OR 97239-3848

Mailing address

5331 SW Macadam Ave Ste 105
Portland, OR 97239-3848
Phone (503) 445-7999

National Provider Directory

National Provider Directory
Tax ID family
Eastside Wellness Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5331 S Macadam Ave
Ste 105
Portland, OR 97239
Phone (503) 445-7999

Practitioners & affiliated clinicians

Practitioners 11

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": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436918400000",
    "number": "1043694433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5331 SW MACADAM AVE STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393848",
            "telephone_number": "503-445-7999",
            "fax_number": "503-445-7997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5331 SW MACADAM AVE STE 105",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393848",
            "telephone_number": "503-445-7999",
            "fax_number": "503-445-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEMENT WELLNESS AND SPORTS REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2015-07-15",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "ENOCH",
        "authorized_official_title_or_position": "MASSAGE THERAPIST",
        "authorized_official_telephone_number": "503-445-7999",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "21383",
            "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 Jul 15, 2015; 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.