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NPI 1629337555

IndividualActive

Jesse Luckett, LMT

NPI 1629337555 · Contractor · Portland, OR

Provider details

NPI number: 1629337555
Entity type: Individual
Primary specialty: ContractorOther Service Providers
Credential: LMT
Sex: Male
Sole proprietor: Yes
License: 7005 (OR)

Practice location

52 Ne Fremont St

Portland, OR 97212-2027

Phone: (503) 381-6636

More OR providers

Mailing address

52 Ne Fremont St

Portland, OR 97212-2027

Registry dates

Enumerated: 2012-05-12
Last updated: 2012-05-12

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.

Jesse Luckett, LMT — NPI 1629337555, Portland, OR | NPI Central