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General NPI Number Information
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NPI Number | 1891475554
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Entity Type | Organization
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Legal Business Name | HOLISTIC MASSAGE AND BODYWORKS
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Dates
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Enumeration Date | 07/18/2023
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 2291 S FORT APACHE RD STE 106
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City | LAS VEGAS
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State | NV
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Zip | 89117-5895
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Country | US
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Telephone | 702-776-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 4262 BLUE DIAMOND RD STE 102-389
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City | LAS VEGAS
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State | NV
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Zip | 89139-7789
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Country | US
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Telephone | 725-248-0251
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | DANIEL JOSHUA AVERY
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Credential |
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Telephone | 725-248-0251
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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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