MEDICARE: GLORIA NELSON LARRIMORE LMT, MMP

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	NVMT.4112	NV

General Provider Information

NPI Number	:	1457895484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA NELSON LARRIMORE LMT, MMP

Provider Business Mailing Address
First Line	:	2750 S DURANGO DR
Second Line	:	APT 1129
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2636
Country	:	US
Telephone Number	:	702-608-1543
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 S DURANGO DR
Second Line	:	APT 1129
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2636
Country	:	US
Telephone Number	:	702-608-1543
Fax Number	:

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

Provider Enumeration Date	:	12/09/2016
Last Update Date	:	12/09/2016

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