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NPI 1699400739 · live from the CMS NPI Registry

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Physical Therapist in Las Vegas, NV. National Provider Identifier 1699400739, active.

NPI record

NPI1699400739 Type 1 · individual
StatusActive
Primary specialtyPhysical Therapist 225100000X
Practice location6021 W Cheyenne Ave, Las Vegas, NV 89108
Practice phone702-658-9494
Mailing address11628 Bollinger Ln, Las Vegas, NV 89141
EnumeratedJuly 21, 2022
Last updatedJuly 21, 2022
Sole proprietorNo

Taxonomies and licenses

TaxonomyCodeLicense
Physical Therapist225100000X5421 (ME)
Physical Therapist primary225100000X4733 (NV)

Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.