Individual provider · Type 1 NPI

Jacob Nickerson, LMT

Massage Therapist · Portland, OR

NPI number 1205390671 Active

Practice location

4305 SE Ellis St
Portland, OR 97206-5758

Call (360) 672-1811 Map

Specialties and licenses

TaxonomyCodeLicense
Massage Therapist Primary 225700000X24524 (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 1205390671

Jacob Nickerson, LMT's National Provider Identifier is 1205390671, issued on Jan 29, 2019. The primary taxonomy on file is Massage Therapist (225700000X), and the practice location is in Portland, OR. The record was last updated on Jan 29, 2019.