MEDICARE: DOUGLAS J KRASNIEWSKI MPT

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	225100000X	Physical Therapist	1708	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013954312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS J KRASNIEWSKI MPT

Provider Business Mailing Address
First Line	:	10785 W TWAIN AVE STE 250
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-3026
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:	725-726-7876

Provider Business Practice Location Address
First Line	:	6590 S RAINBOW BLVD STE 230
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3322
Country	:	US
Telephone Number	:	725-726-7847
Fax Number	:	725-726-7876

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	01/01/2021

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