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General NPI Number Information
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NPI Number | 1114736659
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Entity Type | Individual
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Provider Name | MICHAEL C SMITH
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Gender | Male
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 7477 W LAKE MEAD BLVD STE 240
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City | LAS VEGAS
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State | NV
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Zip | 89128-1027
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Country | US
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Telephone | 702-445-6244
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Fax |
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Provider Business Mailing Address
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Address Line | 1629 SAND CANYON DR
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City | LAS VEGAS
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State | NV
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Zip | 89128-7923
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Country | US
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Telephone | 702-460-2491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NVMT1409
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License Number State | NV
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