Individual provider Active NPI

Amanda Kobelski

  • Massage Therapist
  • Tigard, OR
National Provider Identifier
1679224034
Registry record updated Jan 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
26618 Issued in OR
Practice address
11565 SW Durham Rd
Unit 110
Tigard, OR 97224
Phone
(503) 639-0778
NPI assigned
Jan 17, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 26618 OR Primary

Addresses

Primary practice location

11565 SW Durham Rd
Unit 110
Tigard, OR 97224

Mailing address

11565 SW Durham Rd Ste 110
Tigard, OR 97224-3553
Phone (503) 639-0778

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

LicenseStateTypeSpecialty
26618ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Chiropractic, LLC CurrentSince Jan 26, 2022 Accepting new patients

Locations

11565 SW Durham Rd
Ste 110
Tigard, OR 97224
Phone (503) 639-0774

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1642377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642377600000",
    "number": "1679224034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11565 SW DURHAM RD STE 110",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972243553",
            "telephone_number": "503-639-0778",
            "fax_number": "503-639-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11565 SW DURHAM RD",
            "address_2": "UNIT 110",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "97224",
            "telephone_number": "503-639-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOBELSKI",
        "first_name": "AMANDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-17",
        "last_updated": "2022-01-17",
        "certification_date": "2022-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "26618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; 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.