Provider Demographics
NPI:1013182666
Name:THERAPEUTIC MASSAGING INSOLES
Entity Type:Organization
Organization Name:THERAPEUTIC MASSAGING INSOLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WILTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-966-2414
Mailing Address - Street 1:3280 WYNN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7823
Mailing Address - Country:US
Mailing Address - Phone:702-966-2414
Mailing Address - Fax:702-629-7647
Practice Address - Street 1:3280 WYNN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7823
Practice Address - Country:US
Practice Address - Phone:702-966-2414
Practice Address - Fax:702-629-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier