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General NPI Number Information
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NPI Number | 1750811121
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Entity Type | Organization
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Legal Business Name | BODY THERAPIES OF NEVADA LLC
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 06/18/2017
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Provider Practice Location Address
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Address Line | 7830 W ANN RD STE 140
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City | LAS VEGAS
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State | NV
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Zip | 89149-5605
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Country | US
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Telephone | 702-838-3587
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 TROPICAL SANDS AVE
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-1167
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Country | US
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Telephone | 17028383587
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. GERSON VARGAS
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Credential |
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Telephone | 702-838-3587
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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 | P65-00141
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License Number State | NV
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