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General NPI Number Information
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NPI Number | 1720956188
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Entity Type | Organization
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Legal Business Name | WILD HART MASSAGE LLC
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1831 SE 7TH AVE STE 201
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City | PORTLAND
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State | OR
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Zip | 97214-3580
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Country | US
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Telephone | 503-300-6383
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Fax |
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Provider Business Mailing Address
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Address Line | 620 SW 5TH AVE STE 900 PMB 168
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City | PORTLAND
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State | OR
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Zip | 97204-1431
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Country | US
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Telephone | 971-400-7267
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Fax |
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Authorized Official
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Title or Position | OWNER/FOUNDER
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Name | FOREST DAY HART
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Credential | LMT
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Telephone | 971-400-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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