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General NPI Number Information
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NPI Number | 1427361161
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Entity Type | Organization
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Legal Business Name | INCLINE VILLAGE MASSAGE AND BODYWORKS LLC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 923 INCLINE WAY # 21
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City | INCLINE VILLAGE
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State | NV
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Zip | 89451-9765
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Country | US
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Telephone | 775-831-2123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6401
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City | INCLINE VILLAGE
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State | NV
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Zip | 89450-6401
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Country | US
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Telephone | 775-831-2123
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MICHAEL S DOOLEY
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Credential | LMT, MMP
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Telephone | 775-831-2123
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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 | NVMT 2830
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License Number State | NV
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