Healthcare Provider Details

I. General information

NPI: 1225273618
Provider Name (Legal Business Name): SUZY L FAUST MMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 RED SATURN DR
LAS VEGAS NV
89130-5168
US

IV. Provider business mailing address

5817 RED SATURN DR
LAS VEGAS NV
89130-5168
US

V. Phone/Fax

Practice location:
  • Phone: 702-538-4458
  • Fax:
Mailing address:
  • Phone: 702-538-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT2795
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: