Enatalem Getachew Ejerssa

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

R02544 Issued in MD

Practice address

1215 Palmer Rd Apt 1
Fort Washington, MD 20744-7143

Phone

(510) 692-2053

NPI assigned

Jun 3, 2021

Last updated

Jun 3, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

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": "1622678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1407422033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 PALMER RD APT 1",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207447143",
            "telephone_number": "510-692-2053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 PALMER RD APT 1",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207447143",
            "telephone_number": "510-692-2053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EJERSSA",
        "first_name": "ENATALEM",
        "middle_name": "GETACHEW",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-03",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM1400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Nurse Massage Therapist (NMT)",
            "state": "VA",
            "license": "0019017981",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MD",
            "license": "R02544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Massage Therapist in Fort Washington, MD
• Providers in Fort Washington, MD by specialty
• Massage Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2021; 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.