Healthcare Provider Details

I. General information

NPI: 1407120561
Provider Name (Legal Business Name): KEISHA HARRIS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KOI HARRIS LMT

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 E SUNSET RD STE 119
LAS VEGAS NV
89120-4906
US

IV. Provider business mailing address

831 CORONADO CENTER DR APT 5107
HENDERSON NV
89052-4271
US

V. Phone/Fax

Practice location:
  • Phone: 213-985-9643
  • Fax:
Mailing address:
  • Phone: 213-985-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT.12318
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: