Elijah Maxwell, LMP

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA60590359 Issued in WA

Practice address

1639 Kresky Ave
Centralia, WA 98531-8912

Phone

(360) 807-4711

NPI assigned

Mar 27, 2016

Last updated

Aug 11, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1459036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1275995417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 LAUREL LN",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985311522",
            "telephone_number": "360-819-9728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1639 KRESKY AVE",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985318912",
            "telephone_number": "360-807-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "ELIJAH",
        "credential": "LMP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-27",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "WA",
            "license": "MA60590359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Centralia, WA
• Providers in Centralia, WA by specialty
• Massage Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; 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.