Active NPI
Ellyn Sue Vandenberg, LMT
- Massage Therapist
- Bend, OR
National Provider Identifier
1699631374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 5129
- Practice address
- 2955 N Hwy 97
Bend, OR 97703-7559 - Phone
- (541) 728-3004
- NPI assigned
- Dec 26, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 | 5129 | OR | Primary |
Addresses
Primary practice location
2955 N Hwy 97
Bend, OR 97703-7559
Mailing address
63987 Sunset Dr
Bend, OR 97703-8590
Phone (541) 280-5045
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 |
|---|---|---|---|
| 5129 | OR | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1766707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766707200000",
"number": "1699631374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63987 SUNSET DR",
"city": "BEND",
"state": "OR",
"postal_code": "977038590",
"telephone_number": "541-280-5045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2955 N HWY 97",
"city": "BEND",
"state": "OR",
"postal_code": "977037559",
"telephone_number": "541-728-3004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDENBERG",
"first_name": "ELLYN",
"middle_name": "SUE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-12-26",
"last_updated": "2025-12-26",
"certification_date": "2025-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "OR",
"license": "5129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 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.