MEDICARE: PAYTON ELIZABETH PETRY

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	29472	OR

General Provider Information

NPI Number	:	1225997612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYTON ELIZABETH PETRY

Provider Business Mailing Address
First Line	:	800 NE EVANS RD
Second Line	:
City	:	CORBETT
State	:	OR
Zip	:	97019-7602
Country	:	US
Telephone Number	:	503-459-3524
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 NE ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-5048
Country	:	US
Telephone Number	:	503-287-1444
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ PAYTON ELIZABETH PETRY ” Practice Location

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