MEDICARE: MS. SUSAN MARIE STONE L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172M00000X	Mechanotherapist	0314	NV

General Provider Information

NPI Number	:	1023418167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN MARIE STONE L.M.T.

Provider Business Mailing Address
First Line	:	8292 HUXLEY ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-2377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	139 E WARM SPRINGS RD
Second Line	:	ST. 120
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4101
Country	:	US
Telephone Number	:	702-605-8610
Fax Number	:	702-722-5399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2014

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