Active NPI
Sydney Nettles, LMT
- Massage Therapist
- Portland, OR
National Provider Identifier
1043055825
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 27516
- Practice address
- 1111 SE Stephens St
Portland, OR 97214-4748 - Phone
- (971) 544-7058
- NPI assigned
- Jun 25, 2024
- Sex
- Female
- Sole proprietor
- No
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 | 27516 | OR | Primary |
Addresses
Primary practice location
1111 SE Stephens St
Portland, OR 97214-4748
Mailing address
1111 SE Stephens St
Portland, OR 97214-4748
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 |
|---|---|---|---|
| 27516 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Care Chiropractic, LLC | Massage Therapist | Current | Accepting new patients |
Locations
1111 SE Stephens St
Portland, OR 97214
Phone (503) 461-9664
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719273600000",
"number": "1043055825",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 SE STEPHENS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144748"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 SE STEPHENS ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972144748",
"telephone_number": "971-544-7058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NETTLES",
"first_name": "SYDNEY",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-25",
"last_updated": "2024-06-25",
"certification_date": "2024-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "27516",
"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 Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.