NPIMap

Individual provider Active NPI

Jessica Glisson, LMT

  • Massage Therapist
  • Portland, OR
National Provider Identifier
1730441171
Registry record updated Jul 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
18512 Issued in OR
Practice address
107 SE Washington St
Suite#134
Portland, OR 97214-2103
Phone
(503) 236-6633
NPI assigned
Jun 12, 2012
Last updated
Jul 9, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2012

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 18512 OR Primary

Addresses

Primary practice location

107 SE Washington St
Suite#134
Portland, OR 97214-2103

Mailing address

1426 SE 25TH Ave
Apt 5
Portland, OR 97214-3966
Phone (503) 348-9774

Other names 1

  • Jessica Glisson Professional name

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
18512ORMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
An Sen Clinic 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341792000000",
    "number": "1730441171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1426 SE 25TH AVE",
            "address_2": "APT 5",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972143966",
            "telephone_number": "503-348-9774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 SE WASHINGTON ST",
            "address_2": "SUITE#134",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142103",
            "telephone_number": "503-236-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLISSON",
        "first_name": "JESSICA",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "18512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GLISSON",
            "credential": "LMT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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 Jul 9, 2012; 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.