Individual
MR. NICHOLAS ELIAS NIGHT I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT/ CST/ AMMP
Contact information
Practice address
27 SUBWAY ST., SUITES D & E, BISBEE, AZ 85603
(520) 255-1519
Mailing address
306 SHATTUCK ST, BISBEE, AZ 85603-1548
(520) 255-1519
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
06002128A
IN
225700000X
Massage Therapist
MA 00007960
WA
225700000X
Massage Therapist
MA 37184
FL
225700000X
Massage Therapist
Primary
MT08447
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121-001-000
US DEPT. OF LABOR PROV. #
WA
01
—
1942313424
NPPES NPI
AZ
01
—
21257-00
NCBTMB LIC. #
WA
01
—
451430-10
NCBTMB CEU PROVIDER
AZ
01
—
601-628-074
UNIFIED BUSINESS IDENTIFI
WA
01
—
81768
LABOR & INDUSTRIES #
WA
01
—
91-1680461
EMPLOYER IDENTIFICATION #
WA
01
—
C-2035
BLUE CROSS BLUE SHIELD PI
WA
01
—
MY8742
REGENCE INSURANCE ID #
WA
Enumeration date
08/17/2006
Last updated
01/28/2013
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