MEDICARE: ATHENA MARIE PERUSSE L.M.T

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	NVMT2283	NV

General Provider Information

NPI Number	:	1821260100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA MARIE PERUSSE L.M.T

Provider Business Mailing Address
First Line	:	3291 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3184
Country	:	US
Telephone Number	:	702-706-2353
Fax Number	:

Provider Business Practice Location Address
First Line	:	3291 E WARM SPRINGS RD STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3184
Country	:	US
Telephone Number	:	702-706-2353
Fax Number	:

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

Provider Enumeration Date	:	03/27/2008
Last Update Date	:	11/12/2024

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