Elissa Jean-Marie Youngbluth, L.M.T.

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MAS-4223 Issued in ID

Practice address

1915 N Farwell LN Apt 101
Boise, ID 83713-1180

Phone

(208) 866-8757

NPI assigned

Dec 13, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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": "1639353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1669131082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 N FARWELL LN APT 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131180",
            "telephone_number": "208-866-8757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 N FARWELL LN APT 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131180",
            "telephone_number": "208-866-8757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLUTH",
        "first_name": "ELISSA",
        "middle_name": "JEAN-MARIE",
        "credential": "L.M.T.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ID",
            "license": "MAS-4223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Viktor@korffmassage.com",
            "affiliation": "N",
            "address_1": "1915 N Farwell Ln Apt 101",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837131180",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tracy M Young, FNP
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• Eileen Youngblood, AGPCNP-C
• Jodee L Youngblood
• Scott Bradley Youngblood
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• Z Inc (Pauls Pharmacy #11)

• Massage Therapist in Boise, ID
• Providers in Boise, ID by specialty
• Massage Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.