Active NPI
Tyra Mae Potter, LMT
- Massage Therapist
- Eugene, OR
National Provider Identifier
1912762576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 27679
- Practice address
- 591 W 19TH Ave
Eugene, OR 97401-3827 - Phone
- (541) 243-7697
- NPI assigned
- Feb 13, 2024
- Sex
- Female
- 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 | 27679 | OR | Primary |
Addresses
Primary practice location
591 W 19TH Ave
Eugene, OR 97401-3827
Mailing address
1877 Emerald St Apt 11
Eugene, OR 97403-1460
Phone (541) 206-8420
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 |
|---|---|---|---|
| 27679 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunrise Healing Center | Massage Therapist | Current | Accepting new patients |
Locations
591 W 19th Ave
Eugene, OR 97401
Phone (541) 243-7697
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707782400000",
"number": "1912762576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1877 EMERALD ST APT 11",
"city": "EUGENE",
"state": "OR",
"postal_code": "974031460",
"telephone_number": "541-206-8420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "591 W 19TH AVE",
"city": "EUGENE",
"state": "OR",
"postal_code": "974013827",
"telephone_number": "541-243-7697"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTTER",
"first_name": "TYRA",
"middle_name": "MAE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-13",
"last_updated": "2024-02-13",
"certification_date": "2024-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "27679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eugene, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.