Ethan Jeffries, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

25719 Issued in OR

Practice address

4253 SE 182ND Ave
Gresham, OR 97030-5083

Phone

(503) 661-5090

NPI assigned

Mar 16, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Whitaker Wellness LLC

  • Clinic/Center
  • Gresham, OR
  • NPI 1831641505
  NPD

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

{
    "created_epoch": "1584316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584316800000",
    "number": "1699301119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "892 E HISTORIC COLUMBIA RIVER HWY",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970602166",
            "telephone_number": "309-370-9379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4253 SE 182ND AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305083",
            "telephone_number": "503-661-5090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEFFRIES",
        "first_name": "ETHAN",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-16",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "25719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheryl Jardine, LPC, QMHP
• Anthony Dion Jarrard, PSS/QMHAI
• Kenneth Jasperse, AA
• Michael Jedlicka, SLP
• Ariel Jeffreys, LMT
• Jonas Jenkins, MS, CCC-SLP
• Marteen Jensen, LPC
• Kathryn Elizabeth Jepsen, RN
• Kayla Jerde, PA-C
• Emilee Nicole Jergensen, DC

• Massage Therapist in Gresham, OR
• Providers in Gresham, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2020; 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.