MEDICARE: MS. MICHELE M PUSATIER LMT

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	4590	NV

General Provider Information

NPI Number	:	1487952529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE M PUSATIER LMT

Provider Business Mailing Address
First Line	:	5897 STERLING MOON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1970
Country	:	US
Telephone Number	:	716-868-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	5897 STERLING MOON AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-1970
Country	:	US
Telephone Number	:	716-868-1850
Fax Number	:

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

Provider Enumeration Date	:	03/12/2011
Last Update Date	:	03/12/2011

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