Ted Bagley, LMT
Individual provider Active NPI Massage Therapist · Portland, OR
NPI 1962199836 · NPPES record last updated Apr 20, 2023
Key facts
- NPI
- 1962199836
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 25819 (OR)
- Practice address
- 2262 N Albina Ave Ste 127
Portland, OR 97227-1793 - Phone
- (503) 250-4053
- NPI assigned
- Apr 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 25819 | OR | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 25819 | OR | Yes |
Addresses
Primary practice location
2262 N Albina Ave Ste 127
Portland, OR 97227-1793
Mailing address
4336 SE 48TH Ave
Portland, OR 97206-4064
Phone (503) 250-4053
Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2023. 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.