Active NPI
Jeremy R Radke, LMT
- Massage Therapist
- Salem, OR
National Provider Identifier
1306695077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 28270
- Practice address
- 3523 Fairview Industrial Dr SE
Salem, OR 97302-1155 - Phone
- (971) 453-0800
- NPI assigned
- May 15, 2024
- Sex
- Male
- 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 | 28270 | OR | Primary |
Addresses
Primary practice location
3523 Fairview Industrial Dr SE
Salem, OR 97302-1155
Mailing address
154 SE Foundation Dr
Dallas, OR 97338-9787
Phone (971) 240-8484
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 |
|---|---|---|---|
| 28270 | OR | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750550400000",
"number": "1306695077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 SE FOUNDATION DR",
"city": "DALLAS",
"state": "OR",
"postal_code": "973389787",
"telephone_number": "971-240-8484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3523 FAIRVIEW INDUSTRIAL DR SE",
"city": "SALEM",
"state": "OR",
"postal_code": "973021155",
"telephone_number": "971-453-0800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADKE",
"first_name": "JEREMY",
"middle_name": "R",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-05-15",
"last_updated": "2025-06-22",
"certification_date": "2025-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "28270",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.