Active NPI
Myra Theriault, LAC
- Acupuncturist
- Portland, OR
National Provider Identifier
1861864076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC174883
- Practice address
- 4424 NE Glisan St
Portland, OR 97213-2331 - Phone
- (503) 477-5167
- NPI assigned
- Oct 27, 2015
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC174883 | OR | Primary |
Addresses
Primary practice location
4424 NE Glisan St
Portland, OR 97213-2331
Mailing address
4424 NE Glisan St
Portland, OR 97213-2331
Phone (971) 258-0902
Other practice location 1
4783 US 101
Lincoln City, OR 97367
Phone (541) 994-1819
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 |
|---|---|---|---|
| AC174883 | OR | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services - Oregon | 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 and National Provider Directory roles.
-
- Internal Medicine Physician
- Sherwood, OR
- NPI 1184729329
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1607299200000",
"number": "1861864076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4424 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132331",
"telephone_number": "971-258-0902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4424 NE GLISAN ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972132331",
"telephone_number": "503-477-5167"
}
],
"practiceLocations": [
{
"address_1": "4783 US 101",
"address_purpose": "LOCATION",
"city": "Lincoln City",
"state": "OR",
"postal_code": "97367",
"country_code": "US",
"telephone_number": "541-994-1819",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "THERIAULT",
"first_name": "MYRA",
"credential": "LAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-27",
"last_updated": "2020-12-07",
"certification_date": "2020-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "OR",
"license": "AC174883",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.