Active NPI
Desiree Fredenburg, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1114231891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 16509
- Practice address
- 2627 NE Broadway St
Portland, OR 97232-1720 - Phone
- (503) 281-0278
- NPI assigned
- Aug 4, 2010
- Last updated
- Aug 4, 2010
- Sex
- Female
- Sole proprietor
- No
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 | 16509 | OR | Primary |
Addresses
Primary practice location
2627 NE Broadway St
Portland, OR 97232-1720
Mailing address
1515 SE 52ND Ave
Portland, OR 97215-3315
Phone (503) 914-8500
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280880000000",
"number": "1114231891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1515 SE 52ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972153315",
"telephone_number": "503-914-8500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2627 NE BROADWAY ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321720",
"telephone_number": "503-281-0278"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDENBURG",
"first_name": "DESIREE",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-04",
"last_updated": "2010-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "16509",
"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 Aug 4, 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.