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NPI Code Detail

MEDICARE: LEANNE CARRILLO P.T.

MEDICARE: LEANNE CARRILLO P.T.
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 Therapist2182NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12182OTHERNVSTATE OF NEVADA BOARD OF PHYSICAL THERAPY EXAMINERS

General Provider Information

NPI Number : 1740429661
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEANNE CARRILLO P.T.
Provider Business Mailing Address
First Line : 3663 E SUNSET RD
Second Line : SUITE 503
City : LAS VEGAS
State : NV
Zip : 89120-3218
Country : US
Telephone Number : 702-434-2800
Fax Number : 702-451-1034
Provider Business Practice Location Address
First Line : 9975 S EASTERN AVE
Second Line : SUITE 110
City : LAS VEGAS
State : NV
Zip : 89183-7949
Country : US
Telephone Number : 702-434-2800
Fax Number : 702-451-1034
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2009
Last Update Date : 02/17/2009

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Directions to “ LEANNE CARRILLO P.T.” Practice Location

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