Active NPI
Casey Tyrone Gates, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1477070043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 023247
- Practice address
- 3109 NE Broadway St Ste B
Portland, OR 97232-1812 - Phone
- (971) 413-3106
- NPI assigned
- Aug 24, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 023247 | OR | Primary |
Addresses
Primary practice location
3109 NE Broadway St Ste B
Portland, OR 97232-1812
Mailing address
4118 SE Yamhill St
Portland, OR 97214-4447
Phone (971) 413-3106
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 |
|---|---|---|---|
| 023247 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1503532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1503532800000",
"number": "1477070043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4118 SE YAMHILL ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144447",
"telephone_number": "971-413-3106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3109 NE BROADWAY ST STE B",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972321812",
"telephone_number": "971-413-3106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GATES",
"first_name": "CASEY",
"middle_name": "TYRONE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-08-24",
"last_updated": "2017-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "023247",
"primary": true
}
],
"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 Aug 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.