NPIMap

Organization Active NPI

Greenleaf Soft Tissue Therapy LLC

  • General Practice Physician
  • Bangor, PA
National Provider Identifier
1942897459
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
GREENLEAF SOFT TISSUE THERAPY LLC
Practice address
32 Market St
Bangor, PA 18013-1902
Phone
(610) 452-9021
NPI assigned
Dec 30, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Marissa SpencerNPI 1366039885
Title
Owner/Manager
Phone
(610) 452-9021

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Massage TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225700000X

Addresses

Primary practice location

32 Market St
Bangor, PA 18013-1902

Mailing address

32 Market St
Bangor, PA 18013-1902
Phone (610) 452-9021

Other practice location 1

14 Mount Bethel Plz
Mount Bethel, PA 18343-5212
Phone (610) 452-9021

National Provider Directory

National Provider Directory

Locations

32 Market St
Bangor, PA 18013
Phone (610) 452-9021

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1942897459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 MARKET ST",
            "city": "BANGOR",
            "state": "PA",
            "postal_code": "180131902",
            "telephone_number": "610-452-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32 MARKET ST",
            "city": "BANGOR",
            "state": "PA",
            "postal_code": "180131902",
            "telephone_number": "610-452-9021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14 Mount Bethel Plz",
            "address_purpose": "LOCATION",
            "city": "Mount Bethel",
            "state": "PA",
            "postal_code": "183435212",
            "country_code": "US",
            "telephone_number": "610-452-9021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREENLEAF SOFT TISSUE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-30",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "SPENCER",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "610-452-9021",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 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.

Verify at the official NPI Registry.