Valorie June Wallace, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

23479 Issued in OR

Practice address

2933 NE Broadway St
Portland, OR 97232-1760

Phone

(971) 236-2963

NPI assigned

Oct 27, 2017

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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

• Body Ritual LLC

  • Massage Therapist
  • Portland, OR
  • NPI 1386238137
  NPD Authorized official

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

{
    "created_epoch": "1509062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615075200000",
    "number": "1497267652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2933 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321760",
            "telephone_number": "971-236-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2933 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321760",
            "telephone_number": "971-236-2963"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6504 NE Siskiyou St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972134572",
            "country_code": "US",
            "telephone_number": "503-327-3819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "VALORIE",
        "middle_name": "JUNE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-10-27",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "23479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "clinicsense.com",
            "affiliation": "N",
            "endpointDescription": "client software",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "client info database",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pdf or csv, any document type",
            "address_1": "2933 NE Broadway St",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972321760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mandi Danielle Wallace
• Mikelia Wallace, MT-BC
• Priscilla Jane Wallace, MD
• Shai Joann Love Wallace
• Suzanne Kapuamailani Wallace, MSW, ASW, LCSW
• Summer Nicole Wallaert
• Martine Rose Wallenberg, MS, ED.D, LMHC, LPC
• Ryan Wallenberg, M.D.
• Daniel Wallenslager, PHARMD
• Olivia R Waller Setniker

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2021; 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.