Nichelle Rain Madison
Individual provider Active NPI Massage Therapist · Ruston, WA
NPI 1710596234 · NPPES record last updated Jul 30, 2020
Key facts
- NPI
- 1710596234
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 61041341 (WA)
- Practice address
- 4901 N Pearl St
Ruston, WA 98407-3119 - Phone
- (253) 370-8671
- NPI assigned
- Jul 30, 2020
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61041341 | WA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 61041341 | WA | Yes |
Addresses
Primary practice location
4901 N Pearl St
Ruston, WA 98407-3119
Mailing address
4901 N Pearl St
Ruston, WA 98407-3119
Phone (253) 370-8671
Other providers in Ruston, WA
- Chelsea N Hu
- Dorian Alaine Hunter
- Iroko Bridge LLC
- Tamara Kay Kabel
- Elizabeth R Lotempio
- Penny McGee-Grant
- Emily McGuire-Wallace
- Aaron Lewis Morrow
- Ayanna Olokunsu
- Emma Peterson
All providers in Ruston, WA · Massage Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.