Active NPI
Mary Wall
- Physical Therapist
- Eugene, OR
National Provider Identifier
1417135559
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1855
- Practice address
- 1446 Lawrence St
Eugene, OR 97401-4592 - Phone
- (541) 683-3274
- NPI assigned
- Jan 31, 2008
- Last updated
- May 7, 2009
- 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 | 7197 | OR | |
| Physical Therapist | 225100000X | 1855 | OR | Primary |
Addresses
Primary practice location
1446 Lawrence St
Eugene, OR 97401-4592
Mailing address
1446 Lawrence St
Eugene, OR 97401-4592
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 |
|---|---|---|---|
| 1855 | OR | MD | Naturopath |
| 7197 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241654400000",
"number": "1417135559",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1446 LAWRENCE ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1446 LAWRENCE ST",
"city": "EUGENE",
"state": "OR",
"postal_code": "974014592",
"telephone_number": "541-683-3274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-31",
"last_updated": "2009-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "7197",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "1855",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.