MEDICARE: MS. ALEXIS MADDEN

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	4686	CA

General Provider Information

NPI Number	:	1447852876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALEXIS MADDEN

Provider Business Mailing Address
First Line	:	9655 ENSWORTH ST # 153-1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6414
Country	:	US
Telephone Number	:	415-735-8503
Fax Number	:

Provider Business Practice Location Address
First Line	:	9655 ENSWORTH ST # 153-1
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-6414
Country	:	US
Telephone Number	:	415-735-8503
Fax Number	:

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

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	11/11/2020

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