Healthcare Provider Details

I. General information

NPI: 1558158154
Provider Name (Legal Business Name): VERNON PRYER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6810 E BROADWAY BLVD
TUCSON AZ
85710-2838
US

IV. Provider business mailing address

7953 S LENNOX LN
TUCSON AZ
85747-9273
US

V. Phone/Fax

Practice location:
  • Phone: 520-257-8982
  • Fax:
Mailing address:
  • Phone: 520-257-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-25745
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: