Active NPI
Lisa Teague, LMT
- Specialist
- Portland, OR
National Provider Identifier
1497936629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11219
- Practice address
- 511 SW 10TH Ave Ste 1109
Portland, OR 97205-2712 - Phone
- (503) 329-3577
- NPI assigned
- Nov 15, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11219 | OR | Primary |
Addresses
Primary practice location
511 SW 10TH Ave Ste 1109
Portland, OR 97205-2712
Mailing address
2083 NW Johnson St. #34
Portland, OR 97209
Phone (503) 329-3577
Other names 1
- Lisa Boal
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 |
|---|---|---|---|
| 11219 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1195084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195084800000",
"number": "1497936629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2083 NW JOHNSON ST. #34",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97209",
"telephone_number": "503-329-3577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 SW 10TH AVE STE 1109",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972052712",
"telephone_number": "503-329-3577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TEAGUE",
"first_name": "LISA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-11-15",
"last_updated": "2007-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "11219",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LISA",
"last_name": "BOAL",
"credential": "LMT",
"code": "1",
"type": "Former Name"
}
]
}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 Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.