Active NPI
Georgia Fountas, LMT
- Massage Therapist
- Gresham, OR
National Provider Identifier
1073869707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 19041
- Practice address
- 22400 SE Stark St
Suite 104
Gresham, OR 97030-2656 - Phone
- (503) 491-5555
- NPI assigned
- Jul 31, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 19041 | OR | Primary |
| Massage Therapist | 225700000X | 1113 | MD |
Addresses
Primary practice location
22400 SE Stark St
Suite 104
Gresham, OR 97030-2656
Mailing address
22400 SE Stark St
Suite 104
Gresham, OR 97030-2656
Phone (503) 491-5555
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 |
|---|---|---|---|
| 1113 | MD | MD | Massage Therapist |
| 19041 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343692800000",
"number": "1073869707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22400 SE STARK ST",
"address_2": "SUITE 104",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970302656",
"telephone_number": "503-491-5555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22400 SE STARK ST",
"address_2": "SUITE 104",
"city": "GRESHAM",
"state": "OR",
"postal_code": "970302656",
"telephone_number": "503-491-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FOUNTAS",
"first_name": "GEORGIA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-07-31",
"last_updated": "2012-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "19041",
"primary": true
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "MD",
"license": "1113",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gresham, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.