Jordan K Deharty, LMT
Massage Therapist in Grants Pass, OR. Individual provider (NPI-1).
NPI number1629680657
StatusActive
Last updated in NPPESAug 20, 2020
Details
- NPI
- 1629680657
- Entity type
- Individual (NPI-1)
- Name
- Jordan K Deharty
- Credential
- LMT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 20, 2020
- Certification date
- Aug 20, 2020
- Last updated
- Aug 20, 2020
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225700000X | Massage Therapist | 21792 | OR | Yes |
Practice location
333 Sw 5th StGrants Pass, OR 97526-2509
Phone 541-507-9894
Mailing address
333 Sw 5th StGrants Pass, OR 97526-2509
Phone 541-507-9894
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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