MEDICARE: CLYDELLE ANNE MARAPAO 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	2754	NV

General Provider Information

NPI Number	:	1316380298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDELLE ANNE MARAPAO MPT

Provider Business Mailing Address
First Line	:	4746 CORTINA RANCHO ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8136
Country	:	US
Telephone Number	:	702-918-5635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2330 PASEO DEL PRADO STE C202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4376
Country	:	US
Telephone Number	:	24-899-3557
Fax Number	:	702-413-6333

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	05/13/2024

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