Active NPI
Angelee Nicole Vandruff, LMT
- Mechanotherapist
- Portland, OR
National Provider Identifier
1568664803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mechanotherapist
- License
- 12229
- Practice address
- 4927 NE 30TH Ave
Portland, OR 97211-7007 - Phone
- (503) 281-0681
- NPI assigned
- May 31, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mechanotherapist | 172M00000X | 12229 | OR | Primary |
Addresses
Primary practice location
4927 NE 30TH Ave
Portland, OR 97211-7007
Mailing address
2827 NE Ainsworth St
Portland, OR 97211-6156
Phone (971) 255-0934
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 |
|---|---|---|---|
| 12229 | OR | MD | Mechanotherapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amy Oldendorf | Past | Accepting new patients | |
| Michelle Reynolds | Past | Accepting new patients |
Organizations & group practices 2
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 Therapist
- Portland, OR
- NPI 1144770645
-
- Acupuncturist
- Portland, OR
- NPI 1851558217
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1568664803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2827 NE AINSWORTH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972116156",
"telephone_number": "971-255-0934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4927 NE 30TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972117007",
"telephone_number": "503-281-0681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDRUFF",
"first_name": "ANGELEE",
"middle_name": "NICOLE",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "172M00000X",
"taxonomy_group": "",
"desc": "Mechanotherapist",
"state": "OR",
"license": "12229",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Jul 8, 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.