Healthcare Provider Details

I. General information

NPI: 1144069972
Provider Name (Legal Business Name): VISTA MASSAGE AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 SW HAMPTON ST STE 140
TIGARD OR
97223-8375
US

IV. Provider business mailing address

7100 SW HAMPTON ST STE 140
TIGARD OR
97223-8375
US

V. Phone/Fax

Practice location:
  • Phone: 971-413-0493
  • Fax: 503-776-7830
Mailing address:
  • Phone: 971-413-0493
  • Fax: 503-776-7830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHELSEA GRAJEDA DAVIS
Title or Position: OWNER
Credential: LMT
Phone: 971-413-0493