Provider Demographics
NPI:1164735809
Name:DOOLEY, MICHAEL SHAWN (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAWN
Last Name:DOOLEY
Suffix:
Gender:M
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6401
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89450-6401
Mailing Address - Country:US
Mailing Address - Phone:775-831-2123
Mailing Address - Fax:
Practice Address - Street 1:923 INCLINE WAY
Practice Address - Street 2:# 21
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-9765
Practice Address - Country:US
Practice Address - Phone:775-831-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT 2830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist