Active NPI
Joseph Leonardo Jordan, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1912469008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 12747
- Practice address
- 3529 NE Bryce St
Portland, OR 97212-1854 - Phone
- (503) 853-1944
- NPI assigned
- Apr 5, 2019
- 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 | 12747 | OR | Primary |
Addresses
Primary practice location
3529 NE Bryce St
Portland, OR 97212-1854
Mailing address
3529 NE Bryce St
Portland, OR 97212-1854
Phone (503) 853-1944
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12747 | Other | OR | WE ARE INDEPENDENT CONTRACTORS |
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 |
|---|---|---|---|
| 12747 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554422400000",
"number": "1912469008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3529 NE BRYCE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121854",
"telephone_number": "503-853-1944"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3529 NE BRYCE ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972121854",
"telephone_number": "503-853-1944"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "JOSEPH",
"middle_name": "LEONARDO",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-05",
"last_updated": "2019-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "12747",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WE ARE INDEPENDENT CONTRACTORS",
"identifier": "12747",
"state": "OR"
}
],
"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 Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.