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NPI Code Detail

MEDICARE: MASSAGE CONNECTION LLC

MEDICARE: MASSAGE CONNECTION 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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1538705876
Entity Type Code : Organization
Provider Name (Legal Business Name) : MASSAGE CONNECTION LLC
Provider Business Mailing Address
First Line : 5350 S CONQUISTADOR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4614
Country : US
Telephone Number : 702-839-8008
Fax Number :
Provider Business Practice Location Address
First Line : 5350 S CONQUISTADOR ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-4614
Country : US
Telephone Number : 702-839-8008
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : MS. LISA DEFURIA
Credential : LMT
Telephone Number : 702-499-2975
Provider Enumeration Date : 11/21/2019
Last Update Date : 11/21/2019

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Directions to “MASSAGE CONNECTION LLC ” Practice Location

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