Active NPI
Janice Carole Modesitt, L.M.T.
- Specialist
- Lake Oswego, OR
National Provider Identifier
1992841555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1035
- Practice address
- 16463 Boones Ferry Rd
Lake Oswego, OR 97035-4259 - Phone
- (503) 699-2955
- NPI assigned
- Jan 30, 2007
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | 1035 | OR | Primary |
Addresses
Primary practice location
16463 Boones Ferry Rd
Lake Oswego, OR 97035-4259
Mailing address
4299 SW Country Woods Court
Lake Oswego, OR 97035
Phone (503) 635-6858
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 |
|---|---|---|---|
| 1035 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992841555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4299 SW COUNTRY WOODS COURT",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "97035",
"telephone_number": "503-635-6858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16463 BOONES FERRY RD",
"city": "LAKE OSWEGO",
"state": "OR",
"postal_code": "970354259",
"telephone_number": "503-699-2955"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODESITT",
"first_name": "JANICE",
"middle_name": "CAROLE",
"name_prefix": "Mrs.",
"credential": "L.M.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "1035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Oswego, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.