Healthcare Provider Details

I. General information

NPI: 1619887692
Provider Name (Legal Business Name): BLUE TIGER MASSAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BVT HLDL HWY STE 465
BEAVERTON OR
97005-4736
US

IV. Provider business mailing address

10700 SW BVT HLDL HWY STE 465
BEAVERTON OR
97005-4736
US

V. Phone/Fax

Practice location:
  • Phone: 503-332-5907
  • Fax:
Mailing address:
  • Phone: 503-332-5907
  • Fax: 833-621-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JENELLE M WOODLIEF
Title or Position: OWNER/LMT
Credential: LMT
Phone: 503-332-5907