Active NPI
Joseph William Gillam, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1891458980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 23871
- Practice address
- 8311 SE 13TH Ave Ste a
Portland, OR 97202-7170 - Phone
- (971) 202-0554
- NPI assigned
- Oct 15, 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 | 23871 | OR | Primary |
Addresses
Primary practice location
8311 SE 13TH Ave Ste a
Portland, OR 97202-7170
Mailing address
8624 SE 17TH Ave Apt 203
Portland, OR 97202-7387
Phone (607) 793-3193
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 |
|---|---|---|---|
| 23871 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1634256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634256000000",
"number": "1891458980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8624 SE 17TH AVE APT 203",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972027387",
"telephone_number": "607-793-3193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8311 SE 13TH AVE STE A",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972027170",
"telephone_number": "971-202-0554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLAM",
"first_name": "JOSEPH",
"middle_name": "WILLIAM",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-10-15",
"last_updated": "2021-10-15",
"certification_date": "2021-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "23871",
"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 Oct 15, 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.