Active NPI
Jaclyn R Regis, LMT
- Massage Therapist
- Beaverton, OR
National Provider Identifier
1902251168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 222313
- Practice address
- 12750 SW 2ND St
Suite 102
Beaverton, OR 97005-2778 - Phone
- (971) 336-5134
- NPI assigned
- Apr 25, 2016
- 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 |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 222313 | OR | Primary |
Addresses
Primary practice location
12750 SW 2ND St
Suite 102
Beaverton, OR 97005-2778
Mailing address
2212 SE Nordlund CT
Hillsboro, OR 97123-6164
Phone (971) 336-5134
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 |
|---|---|---|---|
| 222313 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1461542400000",
"number": "1902251168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2212 SE NORDLUND CT",
"city": "HILLSBORO",
"state": "OR",
"postal_code": "971236164",
"telephone_number": "971-336-5134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12750 SW 2ND ST",
"address_2": "SUITE 102",
"city": "BEAVERTON",
"state": "OR",
"postal_code": "970052778",
"telephone_number": "971-336-5134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REGIS",
"first_name": "JACLYN",
"middle_name": "R",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-25",
"last_updated": "2016-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "222313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaverton, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.