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General NPI Number Information
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NPI Number | 1962840439
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Entity Type | Individual
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Provider Name | GLENN MCCLEISTER LMT, MMT
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Gender | Male
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 06/06/2013
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Provider Practice Location Address
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Address Line | 2595 S CIMARRON RD STE 206
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City | LAS VEGAS
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State | NV
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Zip | 89117-7613
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Country | US
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Telephone | 702-371-3702
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Fax | 702-247-9744
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Provider Business Mailing Address
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Address Line | 4471 ELK POINT CIR
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City | LAS VEGAS
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State | NV
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Zip | 89147-6206
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Country | US
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Telephone | 702-371-3702
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Fax | 702-247-9744
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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 | NVMT.1007
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License Number State | NV
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