Healthcare Provider Details

I. General information

NPI: 1821260100
Provider Name (Legal Business Name): ATHENA MARIE PERUSSE L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 E WARM SPRINGS RD STE 300
LAS VEGAS NV
89120-3184
US

IV. Provider business mailing address

3291 E WARM SPRINGS RD STE 300
LAS VEGAS NV
89120-3184
US

V. Phone/Fax

Practice location:
  • Phone: 702-706-2353
  • Fax:
Mailing address:
  • Phone: 702-706-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberNVMT2283
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: