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NPI Code Detail

MEDICARE: MIRACLE MASSAGE DAY SPA

MEDICARE: MIRACLE MASSAGE DAY SPA
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
1225700000XMassage TherapistNVMT 6871NV

General Provider Information

NPI Number : 1497206155
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIRACLE MASSAGE DAY SPA
Provider Business Mailing Address
First Line : 3415 W CRAIG RD
Second Line : SUITE #209
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5110
Country : US
Telephone Number : 702-636-8598
Fax Number :
Provider Business Practice Location Address
First Line : 3415 W CRAIG RD
Second Line : SUITE #209
City : NORTH LAS VEGAS
State : NV
Zip : 89032-5110
Country : US
Telephone Number : 702-636-8598
Fax Number :
Authorized Official
Title or Position : OWNER
Name : FELICIA WHISENANT
Credential :
Telephone Number : 702-755-5309
Provider Enumeration Date : 10/18/2016
Last Update Date : 10/18/2016

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Directions to “MIRACLE MASSAGE DAY SPA ” Practice Location

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