Healthcare Provider Details

I. General information

NPI: 1841850146
Provider Name (Legal Business Name): MAXWELL MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W 2ND ST STE 200
GRAND ISLAND NE
68803-5463
US

IV. Provider business mailing address

1118 W 11TH ST
GRAND ISLAND NE
68801-4018
US

V. Phone/Fax

Practice location:
  • Phone: 308-289-6370
  • Fax:
Mailing address:
  • Phone: 308-289-6370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALI RENEE RUSSELL
Title or Position: OWNER
Credential: LMT
Phone: 308-289-6370