Bruce Jarrod Kandle, LMT, MP
Individual provider Active NPI Massage Therapist · Weston, OR
NPI 1689059552 · NPPES record last updated Jul 21, 2015
Key facts
- NPI
- 1689059552
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MA 60563683 (WA)
- Practice address
- 77895 Lupine LN
Weston, OR 97886-6006 - Phone
- (541) 566-2725
- NPI assigned
- Jul 21, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|
| 21472 | OR | MD | Massage Therapist |
| MA 60563683 | WA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA 60563683 | WA | Yes |
| Massage Therapist | 225700000X | 21472 | OR |
Addresses
Primary practice location
77895 Lupine LN
Weston, OR 97886-6006
Mailing address
77895 Lupine LN
Weston, OR 97886-6006
Phone (541) 566-2725
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA60563683 | Other | WA | MASSAGE THERAPIST |
| 21472 | Other | OR | MASSAGE THERAPIST |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2015. 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.