Active NPI
Samantha Jo Hargrove, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1982956397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 17047
- Practice address
- 510 NE Dekum St
Portland, OR 97211-2926 - Phone
- (917) 676-5173
- Fax
- (833) 563-0873
- NPI assigned
- Oct 9, 2012
- 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 | 17047 | OR | Primary |
Addresses
Primary practice location
510 NE Dekum St
Portland, OR 97211-2926
Mailing address
9727 N Willamette Blvd
Portland, OR 97203-1443
Phone (917) 676-5173
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 |
|---|---|---|---|
| 17047 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1641340800000",
"number": "1982956397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9727 N WILLAMETTE BLVD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972031443",
"telephone_number": "917-676-5173"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 NE DEKUM ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972112926",
"telephone_number": "917-676-5173",
"fax_number": "833-563-0873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARGROVE",
"first_name": "SAMANTHA",
"middle_name": "JO",
"name_prefix": "Ms.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-09",
"last_updated": "2022-01-05",
"certification_date": "2022-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "17047",
"primary": true
}
],
"identifiers": [],
"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 Jan 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.