MEDICARE: KEARA HALLBERG

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	29363	OR

General Provider Information

NPI Number	:	1275475543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEARA HALLBERG

Provider Business Mailing Address
First Line	:	6205 NE 33RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97211-7311
Country	:	US
Telephone Number	:	612-741-9107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 NE 17TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-3561
Country	:	US
Telephone Number	:	503-659-1212
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KEARA HALLBERG ” Practice Location

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