Healthcare Provider Details

I. General information

NPI: 1578473518
Provider Name (Legal Business Name): NICHOLAS ANTHONY KATSARIS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 N DIVISION ST STE 2
CARSON CITY NV
89703-3832
US

IV. Provider business mailing address

230 GOLD PAN WAY
DAYTON NV
89403-9725
US

V. Phone/Fax

Practice location:
  • Phone: 775-297-5314
  • Fax:
Mailing address:
  • Phone: 775-297-5314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13794
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: