Active NPI
Samuel Kibani
- Massage Therapist
- Lake Oswego, OR
National Provider Identifier
1770164030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 26152
- Practice address
- 3 Monroe Pkwy Ste U
Lake Oswego, OR 97035-8875 - Phone
- (503) 386-5311
- NPI assigned
- Apr 19, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 | 26152 | OR | Primary |
Addresses
Primary practice location
3 Monroe Pkwy Ste U
Lake Oswego, OR 97035-8875
Mailing address
1546 SW 172ND Ter Unit 401
Beaverton, OR 97003-4256
Phone (423) 803-8877
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | elementsmassage.com |
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 |
|---|---|---|---|
| 26152 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618790400000",
"number": "1770164030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1546 SW 172ND TER UNIT 401",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970034256",
"telephone_number": "423-803-8877"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 MONROE PKWY STE U",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970358875",
"telephone_number": "503-386-5311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIBANI",
"first_name": "SAMUEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-19",
"last_updated": "2021-04-19",
"certification_date": "2021-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "26152",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "elementsmassage.com",
"affiliation": "N",
"address_1": "3 Monroe Pkwy Ste U",
"city": "Lake Oswego",
"state": "OR",
"country_code": "US",
"postal_code": "970358875",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.