Individual provider Active NPI

Ellis D Ewing Jr., LMT

  • Massage Therapist
  • Adrian, MI
National Provider Identifier
1609649086
Registry record updated Nov 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Massage TherapistTaxonomy code 225700000X
License
7501014073 Issued in MI
Practice address
1304 W Maumee St Apt 2
Adrian, MI 49221-1836
Phone
(517) 759-2704
NPI assigned
Nov 6, 2023
Last updated
Nov 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2023

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 7501014073 MI Primary

Addresses

Primary practice location

1304 W Maumee St Apt 2
Adrian, MI 49221-1836

Mailing address

1304 W Maumee St Apt 2
Adrian, MI 49221-1836
Phone (517) 759-2704

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
7501014073MIMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1699228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1609649086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 W MAUMEE ST APT 2",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211836",
            "telephone_number": "517-759-2704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 W MAUMEE ST APT 2",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211836",
            "telephone_number": "517-759-2704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWING",
        "first_name": "ELLIS",
        "middle_name": "D",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-06",
        "last_updated": "2023-11-06",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501014073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.