Devon Marie Bruckner, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

22789 Issued in OR

Practice address

289 E Ellendale Ave Ste 101
Dallas, OR 97338-1500

Phone

(503) 623-9676

NPI assigned

Sep 17, 2018

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Devon Stackhouse Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Darrington Physical Therapy LLC

  • Physical Therapist
  • Dallas, OR
  • NPI 1588910319
  NPD (past)
• Spiritual Self Inc.

  • Clinic/Center
  • McMinnville, OR
  • NPI 1730745886
  NPD (past)

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1346724283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 NW ADAMS ST. UNIT C",
            "city": "MCMINNVILLE",
            "state": "OR",
            "postal_code": "97128",
            "telephone_number": "971-237-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 E ELLENDALE AVE STE 101",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381500",
            "telephone_number": "503-623-9676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "DEVON",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-17",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "22789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEVON",
            "last_name": "STACKHOUSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Adam Christopher Brown, BA
• Ashley E Brown, LMFT
• Elizabeth Rosario Brown
• Michelle Leigh Brown
• Richard Willis Brown, LCSW
• Melissa Melly Burger, MELLY
• Darrell C Burton II, M.S.W
• Shelby Butler, CADC-R, CRM
• Jon Buyser
• Jodi L Cabell

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.