Active NPI
Lisa Ann Callery Koontz, RN, LMT
- Massage Therapist
- Salem, OR
National Provider Identifier
1518667153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 13994
- Practice address
- 3521 Mud Puppy LN SE
Salem, OR 97317-9434 - Phone
- (503) 871-7717
- NPI assigned
- Mar 2, 2023
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 096007075RN | OR | |
| Massage Therapist | 225700000X | 13994 | OR | Primary |
Addresses
Primary practice location
3521 Mud Puppy LN SE
Salem, OR 97317-9434
Mailing address
3521 Mud Puppy LN SE
Salem, OR 97317-9434
Phone (503) 871-7717
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 096007075RN | OR | MD | Registered Nurse |
| 13994 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677715200000",
"number": "1518667153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3521 MUD PUPPY LN SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973179434",
"telephone_number": "503-871-7717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3521 MUD PUPPY LN SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973179434",
"telephone_number": "503-871-7717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOONTZ",
"first_name": "LISA",
"middle_name": "ANN CALLERY",
"name_prefix": "Mrs.",
"credential": "RN, LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-02",
"last_updated": "2023-03-02",
"certification_date": "2023-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OR",
"license": "096007075RN",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "13994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.