MEDICARE: MICHAEL C SMITH

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	NVMT1409	NV

General Provider Information

NPI Number	:	1114736659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C SMITH

Provider Business Mailing Address
First Line	:	1629 SAND CANYON DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7923
Country	:	US
Telephone Number	:	702-460-2491
Fax Number	:

Provider Business Practice Location Address
First Line	:	7477 W LAKE MEAD BLVD STE 240
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1027
Country	:	US
Telephone Number	:	702-445-6244
Fax Number	:

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

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	12/30/2024

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Directions to “ MICHAEL C SMITH ” Practice Location

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