MEDICARE: CLINIQUE MASSAGE LLC

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 3434	NV

General Provider Information

NPI Number	:	1528397247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINIQUE MASSAGE LLC

Provider Business Mailing Address
First Line	:	6365 SIMMONS ST
Second Line	:	SUITE 145-119
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7292
Country	:	US
Telephone Number	:	702-497-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	7871 W CHARLESTON BLVD
Second Line	:	SUITE 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8335
Country	:	US
Telephone Number	:	702-497-9345
Fax Number	:

Authorized Official
Title or Position	:	MASSAGE THERAPIST
Name	:	ANGELA MILAFSKY
Credential	:	LMT, MMP
Telephone Number	:	702-497-9345

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	09/15/2010

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