Nicholas Mark Maxwell, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

26275 Issued in OR

Practice address

5300 NE 73Rd Ave
Portland, OR 97218-3717

Phone

(512) 293-7721

NPI assigned

Apr 28, 2021

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": "1619568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1477136455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 NE 73RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972183717",
            "telephone_number": "512-293-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 NE 73RD AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972183717",
            "telephone_number": "512-293-7721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1421 SE Ankeny St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972141471",
            "country_code": "US",
            "telephone_number": "503-284-6996",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "NICHOLAS",
        "middle_name": "MARK",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "OR",
            "license": "26275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Geoffrey Maxwell, MD
• Martin Ray Maxwell Jr., MD
• Megan Maxwell
• Melissa L Maxwell, PHARM. D.
• Molly Maxwell, APRN
• Quinlin Maxwell
• Ruth Maxwell, FNP
• Shoshana Maxwell, DO
• Maxxed Out Acupuncture & Wellness
• May M Chang

• Massage Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Massage Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.