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
1	225700000X	Massage 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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