Active NPI
Rachel-Domenika Radonich, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1598940918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 10652
- Practice address
- 1235 SE Division St
Suite 205
Portland, OR 97202-1099 - Phone
- (503) 713-3406
- NPI assigned
- Jan 3, 2008
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 10652 | OR | Primary |
Addresses
Primary practice location
1235 SE Division St
Suite 205
Portland, OR 97202-1099
Mailing address
1235 SE Division St
Suite 205
Portland, OR 97202-1099
Phone (503) 713-3406
Other names 1
- Domenika Radonich
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 |
|---|---|---|---|
| 10652 | OR | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323993600000",
"number": "1598940918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 SE DIVISION ST",
"address_2": "SUITE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021099",
"telephone_number": "503-713-3406"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1235 SE DIVISION ST",
"address_2": "SUITE 205",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972021099",
"telephone_number": "503-713-3406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADONICH",
"first_name": "RACHEL-DOMENIKA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-03",
"last_updated": "2011-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "10652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "DOMENIKA",
"last_name": "RADONICH",
"code": "5",
"type": "Other 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 Dec 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.