Holographic Body LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

HOLOGRAPHIC BODY LLC

Practice address

3014 NE Killingsworth
Portland, OR 97211

Phone

(541) 954-7091

NPI assigned

Nov 16, 2023

Organization subpart

No

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

Authorized official

Name

Adam Persinger, LMTNPI 1609151539

Title

Owner

Phone

(541) 954-7091

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Adam Persinger, LMT

  • Specialist
  • Portland, OR
  • NPI 1609151539
  NPD Authorized official

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1710752191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3834 NE SIMPSON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972117961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3014 NE KILLINGSWORTH",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97211",
            "telephone_number": "541-954-7091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLOGRAPHIC BODY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "PERSINGER",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-954-7091",
        "authorized_official_credential": "LMT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1356065692",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yolanda Evett Holmes
• Lauren Holmgren, MS
• Camilla Holmlund, COTA/L
• Haimonot Holmon
• Alice Marie Holmquist, MD
• Erin K Holroyd
• Kristen M Holsapple, MSW
• Ashley Holsen, MD
• Keriann L Holsinger
• Imia Alexandra Holston, LMT

• Physical Therapy Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Physical Therapy Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; 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.