Healthcare Provider Details

I. General information

NPI: 1679351779
Provider Name (Legal Business Name): MICHAELIA RAE MANZINI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E CENTER ST STE 12
FALLON NV
89406-3474
US

IV. Provider business mailing address

252 EMIGRANT WAY
FERNLEY NV
89408-4601
US

V. Phone/Fax

Practice location:
  • Phone: 775-316-0382
  • Fax:
Mailing address:
  • Phone: 775-316-0382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14232820-4701
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8325
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: