MEDICARE: LINDA GRIFFIN-HADDOX LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	NVMT.10457	NV
2	225700000X	Massage Therapist	33.021068	OH

General Provider Information

NPI Number	:	1356056733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA GRIFFIN-HADDOX LMT

Provider Business Mailing Address
First Line	:	598 FOSTER SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4467
Country	:	US
Telephone Number	:	937-829-9688
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 FOSTER SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-4467
Country	:	US
Telephone Number	:	937-829-9688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	01/19/2023

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