Provider Demographics
NPI:1477302495
Name:BLUE FOOT HEALING LLC
Entity type:Organization
Organization Name:BLUE FOOT HEALING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDING LMT
Authorized Official - Prefix:
Authorized Official - First Name:PAKE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:503-567-5880
Mailing Address - Street 1:7318 N LEAVITT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-4840
Mailing Address - Country:US
Mailing Address - Phone:503-567-5880
Mailing Address - Fax:866-629-1294
Practice Address - Street 1:7318 N LEAVITT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-4840
Practice Address - Country:US
Practice Address - Phone:503-567-5880
Practice Address - Fax:866-629-1294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty