MEDICARE: MRS. SHANNON DEXTER LMT

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.9003	NV

General Provider Information

NPI Number	:	1083127245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANNON DEXTER LMT

Provider Business Mailing Address
First Line	:	4202 W PINECREST CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4924
Country	:	US
Telephone Number	:	619-861-4818
Fax Number	:

Provider Business Practice Location Address
First Line	:	7324 W CHEYENNE AVE STE 7
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7426
Country	:	US
Telephone Number	:	702-309-0122
Fax Number	:

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

Provider Enumeration Date	:	11/09/2017
Last Update Date	:	11/09/2017

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