Mary Nicole Grizhuk, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

LMT-14584 Issued in OR

Practice address

17221 SE Division St
Portland, OR 97236-1240

Phone

(503) 760-0778

NPI assigned

Nov 30, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Interstate Medical Group LLC

  • Medical Specialty Clinic/Center
  • Portland, OR
  • NPI 1932839776

  Multi-Specialty

  NPD (past)
• J Albing DC LLC

  • Chiropractor
  • Portland, OR
  • NPI 1568293496

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1512000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512000000000",
    "number": "1962916742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13058 FRONTIER PKWY",
            "city": "OREGON CITY",
            "state": "OR",
            "postal_code": "970457738",
            "telephone_number": "503-753-0541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17221 SE DIVISION ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972361240",
            "telephone_number": "503-760-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIZHUK",
        "first_name": "MARY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-11-30",
        "last_updated": "2017-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "14584",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "LMT-14584",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roxanne Ruyle Griswold, FNP
• Sarah Anne Griswold
• Sophie Emmaline Griswold, RN
• Elizabeth Marie Gritzmacher, OTR/L
• Susan Marie Gritzner, PSY.D.
• Janelle Evette Grizzard, LMT
• Kenna N Groat
• Amara Groberg
• Bridget Groce
• James Michael Grochala, PTA

• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2017; 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.