MEDICARE: GRZEGORZ ROS PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	2413	NV

General Provider Information

NPI Number	:	1013233634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRZEGORZ ROS PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	9975 PEACE WAY
Second Line	:	2019
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8256
Country	:	US
Telephone Number	:	702-325-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	5920 S RAINBOW BLVD
Second Line	:	SUITE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4208
Country	:	US
Telephone Number	:	702-248-7903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	08/18/2010

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