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NPI Code Detail

MEDICARE: INTEGRATED EDUCATION SPECIALISTS

MEDICARE: INTEGRATED EDUCATION SPECIALISTS
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
1225100000XPhysical Therapist
2225X00000XOccupational Therapist
3363LF0000XFamily Nurse Practitioner
4235Z00000XSpeech-Language Pathologist

General Provider Information

NPI Number : 1114295938
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTEGRATED EDUCATION SPECIALISTS
Provider Business Mailing Address
First Line : PO BOX 94463
Second Line :
City : LAS VEGAS
State : NV
Zip : 89193-4463
Country : US
Telephone Number : 702-630-5644
Fax Number :
Provider Business Practice Location Address
First Line : 4075 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3416
Country : US
Telephone Number : 702-630-5644
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DR. KYLE KONOLD
Credential : PH.D.
Telephone Number : 702-630-5644
Provider Enumeration Date : 12/07/2011
Last Update Date : 12/07/2011

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Directions to “INTEGRATED EDUCATION SPECIALISTS ” Practice Location

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