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General NPI Number Information
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NPI Number | 1225176894
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Entity Type | Organization
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Legal Business Name | BOULDER CITY MASSAGE
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 1005 ELM ST
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City | BOULDER CITY
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State | NV
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Zip | 89005-2106
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Country | US
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Telephone | 702-293-4112
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 62207
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City | BOULDER CITY
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State | NV
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Zip | 89006-2207
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Country | US
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Telephone | 702-293-4112
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM THOMAS
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Credential | MMP
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Telephone | 702-293-4112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 70-91802
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License Number State | NV
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