Active NPI
Lisa R Brunner, LMT
- Mechanotherapist
- Salem, OR
National Provider Identifier
1114290335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 7809
- Practice address
- 752 Hawthorne Ave NE
Salem, OR 97301-4675 - Phone
- (503) 409-0760
- Fax
- (503) 990-6644
- NPI assigned
- Feb 18, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 7809 | OR | Primary |
Addresses
Primary practice location
752 Hawthorne Ave NE
Salem, OR 97301-4675
Mailing address
752 Hawthorne Ave NE
Salem, OR 97301-4675
Phone (503) 409-0760
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 |
|---|---|---|---|
| 7809 | OR | MD | Mechanotherapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386028800000",
"number": "1114290335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "752 HAWTHORNE AVE NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014675",
"telephone_number": "503-409-0760",
"fax_number": "503-990-6644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "752 HAWTHORNE AVE NE",
"city": "SALEM",
"state": "OR",
"postal_code": "973014675",
"telephone_number": "503-409-0760",
"fax_number": "503-990-6644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNNER",
"first_name": "LISA",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-02-18",
"last_updated": "2013-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "OR",
"license": "7809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.