Active NPI
Joanna L McClish, ATC, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1285690396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 11778
- Practice address
- 5112 NE Glisan St
Portland, OR 97213-2940 - Phone
- (503) 309-1333
- NPI assigned
- Apr 26, 2006
- 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 | 11778 | OR | Primary |
| Athletic Trainer | 2255A2300X | AT-AT-10141269 | OR |
Addresses
Primary practice location
5112 NE Glisan St
Portland, OR 97213-2940
Mailing address
2000 NE 42ND Ave
#209
Portland, OR 97213-1399
Phone (503) 309-1333
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 |
|---|---|---|---|
| AT-AT-10141269 | OR | MD | Athletic Trainer |
| 11778 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350864000000",
"number": "1285690396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 NE 42ND AVE",
"address_2": "#209",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972131399",
"telephone_number": "503-309-1333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5112 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132940",
"telephone_number": "503-309-1333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLISH",
"first_name": "JOANNA",
"middle_name": "L",
"credential": "ATC, LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-26",
"last_updated": "2012-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "11778",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-10141269",
"primary": false
}
],
"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 Oct 22, 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.