Individual provider Active NPI

Charlotte Benjamin

  • Massage Therapist
  • Boise, ID
National Provider Identifier
1104776764
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
7271473 Issued in ID
Practice address
13999 W Wainwright Dr Ste 201
Boise, ID 83713-1967
Phone
(208) 939-0775
Fax
(208) 301-5004
NPI assigned
Feb 2, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Massage Therapist 225700000X 7271473 ID Primary

Addresses

Primary practice location

13999 W Wainwright Dr Ste 201
Boise, ID 83713-1967

Mailing address

13999 W Wainwright Dr Ste 201
Boise, ID 83713-1967
Phone (208) 939-0775

Other names 1

  • Charlotte Woodward Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7271473IDMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Highland Chiropractic PLLC PastSince Oct 22, 2014 Accepting new patients
Active Living Chiropractic & Wellness LLC PastSince Oct 15, 2018 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1104776764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13999 W WAINWRIGHT DR STE 201",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131967",
            "telephone_number": "208-939-0775",
            "fax_number": "208-301-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13999 W WAINWRIGHT DR STE 201",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131967",
            "telephone_number": "208-939-0775",
            "fax_number": "208-301-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENJAMIN",
        "first_name": "CHARLOTTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-02",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ID",
            "license": "7271473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLOTTE",
            "last_name": "WOODWARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.