JACOB NICKERSON LMT
NPI 1205390671
Massage Therapist in Portland, OR

Q: What is Jacob Nickerson's NPI number?

The NPI number for Jacob Nickerson is 1205390671. It was assigned to this individual provider in the NPPES registry on January 29, 2019.

Q: What is Jacob Nickerson's specialty?

The primary specialty registered for this NPI is Massage Therapist with taxonomy code 225700000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Nickerson was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 29, 2019

4305 SE ELLIS ST, PORTLAND, OR 97206(360) 672-1811 Get Directions Write a Review

NPPES record last updated: January 29, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Jacob Nickerson Lmt NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACOB NICKERSON LMT (NPI 1205390671) is an individual massage therapist in Portland, Oregon, licensed in Oregon (24524) and active in the NPI registry since January 2019.

NPPES Registry Identity

NPI1205390671

Entity TypeIndividualMale

Primary Taxonomy225700000X

Provider Legal NameJACOB NICKERSONCredential: LMT

Location Address4305 SE ELLIS STPortland, OR 97206-5758

Mailing Address4305 Se Ellis StPortland, OR 97206-5758 · (360) 672-1811

Phone(360) 672-1811

Sole ProprietorYes

Enumeration DateJanuary 29, 2019

✔ NPI 1205390671 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyMassage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code225700000X

License✔ Licensed in OR · 24524

Definition

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.

4305 SE ELLIS ST, Portland, OR 97206

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Nickerson's NPI number?

The NPI number for Jacob Nickerson is 1205390671. It was assigned to this individual provider in the NPPES registry on January 29, 2019.

Where is Jacob Nickerson located?

Jacob Nickerson practices at 4305 SE Ellis St, Portland, OR 97206. The listed phone number is (360) 672-1811.

What is Jacob Nickerson's specialty?

The primary specialty registered for this NPI is Massage Therapist with taxonomy code 225700000X.

When was this NPI record last updated?

The NPPES record for Jacob Nickerson was last updated on January 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.