MEDICARE: HEATHER GORDON MASSAGE THERAPIST

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.5570	NV

General Provider Information

NPI Number	:	1699405654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GORDON MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	8301 W CHARLESTON BLVD APT 2075
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8301 W CHARLESTON BLVD APT 2075
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1251
Country	:	US
Telephone Number	:	702-875-6029
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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Directions to “ HEATHER GORDON MASSAGE THERAPIST” Practice Location

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