MEDICARE: MR. LES SLAUGHTER LMT,MMP,TRT

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	NVMT0089	NV

General Provider Information

NPI Number	:	1396907937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LES SLAUGHTER LMT,MMP,TRT

Provider Business Mailing Address
First Line	:	6317 PORTOLA RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3920
Country	:	US
Telephone Number	:	702-807-8137
Fax Number	:	702-658-0883

Provider Business Practice Location Address
First Line	:	3211 N TENAYA WAY
Second Line	:	SUITE #110
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7439
Country	:	US
Telephone Number	:	702-807-8137
Fax Number	:	702-658-0883

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	06/25/2008

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