Steven John Jackson, LMT

Individual provider Active NPI Massage Therapist · Pomeroy, WA

NPI 1255224960 · NPPES record last updated Jun 2, 2025

Key facts

NPI
1255224960
Entity type
Individual (NPI type 1)
Primary specialty
Massage Therapist 225700000X
License
2171967 (ID)
Practice address
256 13TH St
Pomeroy, WA 99347-1301
Phone
(509) 844-8189
NPI assigned
Jun 2, 2025
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

LicenseStateTypeSpecialty
2171967IDMDMassage Therapist
MA61679087WAMDMassage Therapist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X MA61679087 WA
Massage Therapist 225700000X 2171967 ID Yes

Addresses

Primary practice location

256 13TH St
Pomeroy, WA 99347-1301

Mailing address

PO Box 887
Pomeroy, WA 99347-0887
Phone (509) 844-5071

Other providers in Pomeroy, WA

All providers in Pomeroy, WA · Massage Therapist in Washington

Sources for this page

Verify at the official NPI Registry.