ROOTS WELLNESS MASSAGE LLC NPI 1124926738

NPI Information

  • NPI: 1124926738
  • Provider Name: ROOTS WELLNESS MASSAGE, LLC
  • Classification: Massage Therapist - 225700000X
  • Entity Type: Organization
  • Address: 1217 NE BURNSIDE RD STE 604
    GRESHAM, OR
    ZIP 97030
  • Phone: (360) 566-5907

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NPI Details

ROOTS WELLNESS MASSAGE, LLC is a massage therapist in Gresham, OR. The provider is an individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. ROOTS WELLNESS MASSAGE, LLC NPI is 1124926738. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1217 NE BURNSIDE RD STE 604
GRESHAM, OR
ZIP 97030-770
Phone: (360) 566-5907

The provider's authorized official is Dominique Louise Garrison .
The authorized official title is Owner and has the following contact phone number (360) 566-5907.

The enumeration date for this NPI number is 10/26/2026 and was last updated on 10/26/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1225700000XMassage TherapistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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