MEDICARE: STEVEN PACE PTA

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	225200000X	Physical Therapy Assistant	A-0927	NV

General Provider Information

NPI Number	:	1649623810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN PACE PTA

Provider Business Mailing Address
First Line	:	6241 MERCER VALLEY ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6512
Country	:	US
Telephone Number	:	801-814-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 W ANN RD
Second Line	:	#110
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4411
Country	:	US
Telephone Number	:	702-396-7100
Fax Number	:

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

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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