Individual provider · Type 1 NPI

Samuel Jackson Lisieski, LMT

Massage Therapist · Portland, OR

NPI number 1063243582 Active

Practice location

7925 SE Stark St
Portland, OR 97215-2341

Call (503) 785-9914 Map

Mailing address

326 NE 78th Ave
Portland, OR 97213-6339

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X28282 (OR)

Massage Therapist: An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes.

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About NPI 1063243582

Samuel Jackson Lisieski, LMT's National Provider Identifier is 1063243582, issued on Aug 8, 2024. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Aug 8, 2024.