MEDICARE: SIERRA BANGS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	29402	OR

General Provider Information

NPI Number	:	1962366997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIERRA BANGS

Provider Business Mailing Address
First Line	:	4526 SE 104TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-3502
Country	:	US
Telephone Number	:	808-937-0153
Fax Number	:

Provider Business Practice Location Address
First Line	:	4526 SE 104TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97266-3502
Country	:	US
Telephone Number	:	808-937-0153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2025
Last Update Date	:	12/13/2025

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Directions to “ SIERRA BANGS ” Practice Location

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