NPI 1013814979 · live from the CMS NPI Registry
Russell Carollo, LMT
Massage Therapist in Columbia, MD. National Provider Identifier 1013814979, active.
NPI record
| NPI | 1013814979 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Massage Therapist 225700000X |
| Practice location | 10630 Little Patuxent Pkwy, Ste 128, Columbia, MD 21044 |
| Practice phone | 443-718-0611 |
| Mailing address | 1806 Mayfield Ave, Halethorpe, MD 21227 |
| Enumerated | October 23, 2026 |
| Last updated | October 23, 2026 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Massage Therapist primary | 225700000X | M07209 (MD) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.