David Michael McGovern, LMT
Individual provider Active NPI Reflexologist · Portland, OR
NPI 1124300322 · NPPES record last updated Sep 13, 2011
Key facts
- NPI
- 1124300322
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Reflexologist 173C00000X
- License
- 17921 (OR)
- Practice address
- 2045 SE Madison St
Apt 15
Portland, OR 97214 - Phone
- (503) 489-9794
- Fax
- (732) 753-7487
- NPI assigned
- Sep 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17921 | OR | MD | Reflexologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Reflexologist | 173C00000X | 17921 | OR | Yes |
Addresses
Primary practice location
2045 SE Madison St
Apt 15
Portland, OR 97214
Mailing address
2045 SE Madison St
Apt 15
Portland, OR 97214
Phone (503) 489-9794
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.