Wild Moss Wellness LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

WILD MOSS WELLNESS LLC

Practice address

529 SE Grand Ave Ste 300D
Portland, OR 97214-2232

Phone

(503) 410-3013

NPI assigned

Mar 27, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kiya TenneyNPI 1407332745

Title

Owner

Phone

(507) 676-3180

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kiya Tenney, LMT

  • Massage Therapist
  • Portland, OR
  • NPI 1407332745
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1711497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1407607633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "529 SE GRAND AVE STE 300D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "529 SE GRAND AVE STE 300D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142232",
            "telephone_number": "503-410-3013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD MOSS WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-27",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "TENNEY",
        "authorized_official_first_name": "KIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-676-3180"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.

Verify at the official NPI Registry.