MEDICARE: PREMIER PHYSICAL THERAPY

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	1463	NV

General Provider Information

NPI Number	:	1649237876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2213 NORTH 5TH STEET
Second Line	:	SUITE B
City	:	ELKO
State	:	NV
Zip	:	89801-2471
Country	:	US
Telephone Number	:	775-777-0901
Fax Number	:	775-777-0923

Provider Business Practice Location Address
First Line	:	2213 NORTH 5TH STEET
Second Line	:	SUITE B
City	:	ELKO
State	:	NV
Zip	:	89801-2471
Country	:	US
Telephone Number	:	775-777-0901
Fax Number	:	775-777-0923

Authorized Official
Title or Position	:	PHYSICAL THERAPIST / OWNER
Name	:	MR. MARC PATTEN GROW
Credential	:	P.T.
Telephone Number	:	775-777-0901

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/15/2007

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Directions to “PREMIER PHYSICAL THERAPY ” Practice Location

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