Provider Demographics
NPI:1821260100
Name:PERUSSE, ATHENA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:MARIE
Last Name:PERUSSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3608 E SUNSET RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-7203
Mailing Address - Country:US
Mailing Address - Phone:702-352-3358
Mailing Address - Fax:
Practice Address - Street 1:3608 E SUNSET RD STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-7203
Practice Address - Country:US
Practice Address - Phone:702-352-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT2283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist