Provider Demographics
NPI:1538705876
Name:MASSAGE CONNECTION LLC
Entity Type:Organization
Organization Name:MASSAGE CONNECTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFURIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:702-499-2975
Mailing Address - Street 1:5350 S CONQUISTADOR ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4614
Mailing Address - Country:US
Mailing Address - Phone:702-839-8008
Mailing Address - Fax:
Practice Address - Street 1:5350 S CONQUISTADOR ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4614
Practice Address - Country:US
Practice Address - Phone:702-839-8008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty