Active NPI
Ethan Boswell, LMT
- Massage Therapist
- Beaverton, OR
National Provider Identifier
1548072499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 28815
- Practice address
- 12750 SW 2ND St Ste 203
Beaverton, OR 97005-2779 - Phone
- (971) 228-1122
- NPI assigned
- Jan 27, 2025
- Sex
- Male
- Sole proprietor
- No
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 | 28815 | OR | Primary |
Addresses
Primary practice location
12750 SW 2ND St Ste 203
Beaverton, OR 97005-2779
Mailing address
16593 NW Oak Creek Dr
Beaverton, OR 97006-7479
Phone (520) 954-6193
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 |
|---|---|---|---|
| 28815 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1548072499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16593 NW OAK CREEK DR",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970067479",
"telephone_number": "520-954-6193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12750 SW 2ND ST STE 203",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052779",
"telephone_number": "971-228-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSWELL",
"first_name": "ETHAN",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-27",
"last_updated": "2025-01-27",
"certification_date": "2025-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "28815",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.