MEDICARE: KERSEY D FITZPATRICK LMT 29571

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	29571	OR

General Provider Information

NPI Number	:	1528915592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERSEY D FITZPATRICK LMT 29571

Provider Business Mailing Address
First Line	:	3721 SE 13TH AVE APT 3
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97202-3863
Country	:	US
Telephone Number	:	509-531-3449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 SE 12TH AVE OFC 7
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2513
Country	:	US
Telephone Number	:	509-531-3449
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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