Elite Body Therapy LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

13636 Issued in OR

Legal business name

ELITE BODY THERAPY LLC

Practice address

4839 NE Martin Luther King Jr Blvd
Suite 201
Portland, OR 97211-3386

Phone

(503) 544-7778

NPI assigned

Feb 7, 2012

Organization subpart

No

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

Authorized official

Name

Jessie Thompson, L.M.T.

Title

Owner Licensed Massage Therapist

Phone

(503) 544-7778

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1328572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343865600000",
    "number": "1861764862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5803 SE WOODSTOCK BLVD STE 2",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972066705",
            "telephone_number": "503-544-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4839 NE MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 201",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972113386",
            "telephone_number": "503-544-7778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE BODY THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-07",
        "last_updated": "2012-08-02",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "OWNER LICENSED MASSAGE THERAPIST",
        "authorized_official_telephone_number": "503-544-7778",
        "authorized_official_credential": "L.M.T."
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "13636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 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.