Jackson Lee Andrews, LMT
Individual provider Active NPI Massage Therapist · Powell Butte, OR
NPI 1003239104 · NPPES record last updated Jan 24, 2014
Key facts
- NPI
- 1003239104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 20031 (OR)
- Practice address
- 7380 SW Reif Rd
Powell Butte, OR 97753-1513 - Phone
- (541) 213-0491
- NPI assigned
- Jan 24, 2014
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20031 | OR | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 20031 | OR | Yes |
Addresses
Primary practice location
7380 SW Reif Rd
Powell Butte, OR 97753-1513
Mailing address
7380 SW Reif Rd
Powell Butte, OR 97753-1513
Phone (541) 213-0491
Other providers in Powell Butte, OR
- Karin Allumbaugh
- Kristie Bourland
- Brian John Foster
- Mary McKee
- Jeanne Marie Mendazona
- David William Waldram
All providers in Powell Butte, OR · Massage Therapist in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.