MEDICARE: PHYLLIS MARIE PRICE

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	NVMT11006	NV

General Provider Information

NPI Number	:	1750052957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS MARIE PRICE

Provider Business Mailing Address
First Line	:	2059 W 146TH ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90249-3227
Country	:	US
Telephone Number	:	310-462-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2059 W 146TH ST
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90249-3227
Country	:	US
Telephone Number	:	775-241-8798
Fax Number	:

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

Provider Enumeration Date	:	09/27/2021
Last Update Date	:	09/27/2021

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Directions to “ PHYLLIS MARIE PRICE ” Practice Location

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