NPIMap

Organization Active NPI

Revivanation LLC

  • Massage Therapist
  • Portland, OR
National Provider Identifier
1629490388
Registry record updated Jan 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
17523 Issued in OR
Legal business name
REVIVANATION LLC
Practice address
914 SW 11TH Ave
Portland, OR 97205-2001
Phone
(503) 765-5333
Fax
(888) 495-4549
NPI assigned
Jan 15, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2014

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

Authorized official

Name
Mr. Steven M Burbank, LMT
Title
Owner/Therapist
Phone
(503) 765-5333

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 171100000X AC01286 OR
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X 17523 OR Primary
Massage TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225700000X 13830 OR

Addresses

Primary practice location

914 SW 11TH Ave
Portland, OR 97205-2001

Mailing address

914 SW 11TH Ave
Portland, OR 97205-2001
Phone (503) 765-5333

Other names 1

  • eyem Doing business as

National Provider Directory

National Provider Directory

Locations

914 SW 11th Ave
Portland, OR 97205
Phone (503) 427-9358

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1629490388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914 SW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052001",
            "telephone_number": "503-765-5333",
            "fax_number": "888-495-4549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 SW 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052001",
            "telephone_number": "503-765-5333",
            "fax_number": "888-495-4549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVANATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "BURBANK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "503-765-5333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC01286",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "17523",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "13830",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "eyem",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 15, 2014; 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.