David C Derosia, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

16541 Issued in OR

Practice address

2143 NE Broadway St Ste 1
Portland, OR 97232-1512

Phone

(971) 303-8367

NPI assigned

Mar 3, 2011

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1299110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1831497569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 NE BROADWAY ST STE 1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321512",
            "telephone_number": "971-303-8367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2143 NE BROADWAY ST STE 1",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321512",
            "telephone_number": "971-303-8367"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2304 E Burnside St Ste 1",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972141677",
            "country_code": "US",
            "telephone_number": "971-303-8367",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEROSIA",
        "first_name": "DAVID",
        "middle_name": "C",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-03-03",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "16541",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dermatology Professionals
• Craig Scott Dermer, CCC-CLP
• Tom C Deroche, M.D.
• Frances A Derook, M.D.
• Dominique Derosa, RN BSN
• Eileen Alice Derr
• Emily Derr
• Kerri D Derrevere, MD
• Sara Mae Fels Derrickson, ED.S.
• Sean Robert Derrickson III, MSW

• All providers in Portland, OR
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.

Verify at the official NPI Registry.