Individual
ELIJAH MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
1639 KRESKY AVE, CENTRALIA, WA 98531-8912
(360) 807-4711
Mailing address
3110 LAUREL LN, CENTRALIA, WA 98531-1522
(360) 819-9728
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60590359
WA
Other
Enumeration date
03/27/2016
Last updated
08/11/2016
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