Active NPI
Beth W. Mantis, LMT
- Rehabilitation Practitioner
- Eagle Creek, OR
National Provider Identifier
1992056857
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- License
- 18018
- Practice address
- 29544 SE Heiple Rd
Eagle Creek, OR 97022-9664 - Phone
- (503) 887-6070
- Fax
- (503) 630-2860
- NPI assigned
- Oct 1, 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | 18018 | OR | Primary |
Addresses
Primary practice location
29544 SE Heiple Rd
Eagle Creek, OR 97022-9664
Mailing address
29544 SE Heiple Rd
Eagle Creek, OR 97022-9664
Phone (503) 887-6070
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 |
|---|---|---|---|
| 18018 | OR | MD | Rehabilitation Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349049600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349049600000",
"number": "1992056857",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "29544 SE HEIPLE RD",
"city": "EAGLE CREEK",
"state": "OR",
"postal_code": "970229664",
"telephone_number": "503-887-6070",
"fax_number": "503-630-2860"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29544 SE HEIPLE RD",
"city": "EAGLE CREEK",
"state": "OR",
"postal_code": "970229664",
"telephone_number": "503-887-6070",
"fax_number": "503-630-2860"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANTIS",
"first_name": "BETH",
"middle_name": "W.",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-01",
"last_updated": "2012-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": "OR",
"license": "18018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle Creek, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.