MEDICARE: JANAE PRESTON

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	9276	NV

General Provider Information

NPI Number	:	1922612589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAE PRESTON

Provider Business Mailing Address
First Line	:	5540 W HARMON AVE APT 1005
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5123
Country	:	US
Telephone Number	:	984-364-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	5540 W HARMON AVE APT 1005
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5123
Country	:	US
Telephone Number	:	984-364-0076
Fax Number	:

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

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	09/01/2020

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Directions to “ JANAE PRESTON ” Practice Location

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