Embodiment Evolution, LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

EMBODIMENT EVOLUTION, LLC

Doing business as

Eric Van Leeuwen, LMT

Practice address

2403 SE Monroe St Ste B
Milwaukie, OR 97222-7646

Phone

(503) 303-4078

NPI assigned

Aug 11, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Eric Van Leeuwen, LMT

Title

Massage Therapist

Phone

(415) 609-4343

Specialties & licenses 1

Addresses

Other names 1

• Eric Van Leeuwen, LMT Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1225766777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 SE LONG ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025030",
            "telephone_number": "415-609-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 SE MONROE ST STE B",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227646",
            "telephone_number": "503-303-4078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBODIMENT EVOLUTION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "VAN LEEUWEN",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "MASSAGE THERAPIST",
        "authorized_official_telephone_number": "415-609-4343",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eric Van Leeuwen, LMT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Michelle Ellis, BA
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• Patrick Erickson, DO

• Massage Therapist in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.