Active NPI
Edgar Gonzalez, LMT
- Massage Therapist
- Lake Oswego, OR
National Provider Identifier
1689185506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 20741
- Practice address
- 17777 Lower Boones Ferry Rd Ste a
Lake Oswego, OR 97035-5398 - Phone
- (503) 699-5888
- NPI assigned
- Oct 18, 2017
- 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 | 20741 | OR | Primary |
Addresses
Primary practice location
17777 Lower Boones Ferry Rd Ste a
Lake Oswego, OR 97035-5398
Mailing address
5989 SE Harmony Rd Apt 12
Milwaukie, OR 97222-2111
Phone (503) 840-7462
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 |
|---|---|---|---|
| 20741 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bio Foot Reflexology and Massage Center LLC | Massage Therapist | Past | Accepting new patients |
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.
-
- Massage Therapist
- Lake Oswego, OR
- NPI 1396160693
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508284800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508284800000",
"number": "1689185506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5989 SE HARMONY RD APT 12",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972222111",
"telephone_number": "503-840-7462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17777 LOWER BOONES FERRY RD STE A",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970355398",
"telephone_number": "503-699-5888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONZALEZ",
"first_name": "EDGAR",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-18",
"last_updated": "2017-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "20741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.