Jordan K Deharty, LMT
Individual provider Active NPI Massage Therapist · Grants Pass, OR
NPI 1629680657 · NPPES record last updated Aug 20, 2020
Key facts
- NPI
- 1629680657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 21792 (OR)
- Practice address
- 333 SW 5TH St
Grants Pass, OR 97526-2509 - Phone
- (541) 507-9894
- NPI assigned
- Aug 20, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 21792 | OR | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Functional Flexion LLC | Massage Therapist | Current | Accepting new patients |
Locations
1825 Nebraska Ave
Grants Pass, OR 97527
Phone (361) 728-5003
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 21792 | OR | Yes |
Addresses
Primary practice location
333 SW 5TH St
Grants Pass, OR 97526-2509
Mailing address
333 SW 5TH St
Grants Pass, OR 97526-2509
Phone (541) 507-9894
Other providers in Grants Pass, OR
- Amanda Debo
- Carole D Debord
- Lorie T Decarvalho
- Karen Decker-Young
- Rose Marie Deford
- Denise Delamore
- Susan Elizabeth Deland-Garten
- Thayanne Camargo Delima-Tokarz
- Janae Lee Delzell
- Dena Lynn Demello
All providers in Grants Pass, 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 Aug 20, 2020. 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.