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NPI Code Detail

MEDICARE: LARY MICHAELS

MEDICARE: LARY MICHAELS
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1194165753
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARY MICHAELS
Provider Business Mailing Address
First Line : 3535 HAMMOCK ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-3767
Country : US
Telephone Number : 949-241-3701
Fax Number :
Provider Business Practice Location Address
First Line : 3535 HAMMOCK ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-3767
Country : US
Telephone Number : 949-241-3701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2013
Last Update Date : 06/27/2013

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Directions to “ LARY MICHAELS ” Practice Location

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