Healthcare Provider Details

I. General information

NPI: 1821952771
Provider Name (Legal Business Name): JESSE HUDSON LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19355 SW MOHAVE CT
TUALATIN OR
97062-8631
US

IV. Provider business mailing address

6360 SW BEAVERTON HILLSDALE HWY
PORTLAND OR
97221-4223
US

V. Phone/Fax

Practice location:
  • Phone: 503-486-5199
  • Fax: 503-486-5190
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11325
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: