MEDICARE: TRINA LYNETTE SHOOK 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	NVMT.10395	NV

General Provider Information

NPI Number	:	1659035681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRINA LYNETTE SHOOK LMT

Provider Business Mailing Address
First Line	:	2035 CIVIC CENTER DR # 432
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6311
Country	:	US
Telephone Number	:	702-752-0152
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 CIVIC CENTER DR # 432
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-6311
Country	:	US
Telephone Number	:	702-752-0152
Fax Number	:

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

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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Directions to “ TRINA LYNETTE SHOOK LMT” Practice Location

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