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General NPI Number Information
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NPI Number | 1194324616
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Entity Type | Individual
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Provider Name | ASHLEY MICHELLE MACK LMT
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 9525 HILLWOOD DR STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89134-0596
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Country | US
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Telephone | 702-642-5446
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Fax |
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Provider Business Mailing Address
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Address Line | 649 LINESHACK LN
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City | LAS VEGAS
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State | NV
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Zip | 89110-2110
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Country | US
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Telephone | 702-715-7112
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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 |
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License Number State |
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