MEDICARE: DESERT WIND THERAPEUTICS LLC

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	225700000X	Massage Therapist	NVMT-001	NV

General Provider Information

NPI Number	:	1073848362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT WIND THERAPEUTICS LLC

Provider Business Mailing Address
First Line	:	2860 E FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5271
Country	:	US
Telephone Number	:	702-731-2128
Fax Number	:	866-378-3528

Provider Business Practice Location Address
First Line	:	2860 E FLAMINGO RD
Second Line	:	SUITE A
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5271
Country	:	US
Telephone Number	:	702-731-2128
Fax Number	:	866-378-3528

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. MICHELLE A. VIESSELMAN
Credential	:	LMT
Telephone Number	:	702-731-2128

Provider Enumeration Date	:	10/05/2009
Last Update Date	:	10/05/2009

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