Active NPI
Dawn Russell, LMT
- Massage Therapist
- New Palestine, IN
National Provider Identifier
1225675184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT21003734
- Practice address
- 4839 W Oak Dr
New Palestine, IN 46163-9648 - Phone
- (317) 525-5707
- NPI assigned
- Dec 10, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT21003734 | IN | Primary |
Addresses
Primary practice location
4839 W Oak Dr
New Palestine, IN 46163-9648
Mailing address
4839 W Oak Dr
New Palestine, IN 46163-9648
Phone (317) 525-5707
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
| License | State | Type | Specialty |
|---|---|---|---|
| MT21003734 | IN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578182400000",
"number": "1225675184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4839 W OAK DR",
"city": "NEW PALESTINE",
"state": "IN",
"postal_code": "461639648",
"telephone_number": "317-525-5707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4839 W OAK DR",
"city": "NEW PALESTINE",
"state": "IN",
"postal_code": "461639648",
"telephone_number": "317-525-5707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSSELL",
"first_name": "DAWN",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-10",
"last_updated": "2020-01-05",
"certification_date": "2020-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT21003734",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Palestine, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.