Kelly L Von Bargen, PTA, LMT

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

09654 Issued in OR

Practice address

4560 SE International Way Ste 100
Milwaukie, OR 97222-4628

Phone

(971) 206-2314

NPI assigned

Jan 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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 and National Provider Directory roles.

• Massage for Healing and Wellness

  • Massage Therapist
  • Gresham, OR
  • NPI 1356888093
  NPD (past) Authorized official

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541030400000",
    "number": "1508302241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "287 NE 3RD ST APT 209",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970307722",
            "telephone_number": "971-361-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 SE INTERNATIONAL WAY STE 100",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972224628",
            "telephone_number": "971-206-2314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "287 NE 3rd St Apt 209",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970307722",
            "country_code": "US",
            "telephone_number": "971-361-6349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VON BARGEN",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "PTA, LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-18",
        "last_updated": "2018-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "22780",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "OR",
            "license": "09654",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Jisell Virgen-Chavez
• Virtue at the Pointe Recovery Center LLC
• David Harold Vistaunet, PT
• Vitality Massage Clinic
• Kristina A Volpe, PT DPT
• Somchanh Vongsoury
• Colter Voss, MD
• Kyira Wackett, MS, LPC
• Sue A Wagner, MA CCC SLP
• Helane Wahbeh

• Physical Therapy Assistant in Milwaukie, OR
• Providers in Milwaukie, OR by specialty
• Physical Therapy Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2018; 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.