MEDICARE: AURORA PEDIATRIC THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1780331686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURORA PEDIATRIC THERAPY LLC

Provider Business Mailing Address
First Line	:	7450 S EASTERN AVE UNIT 1121
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1560
Country	:	US
Telephone Number	:	907-268-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	7450 S EASTERN AVE UNIT 1121
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1560
Country	:	US
Telephone Number	:	907-268-7533
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SICO LY
Credential	:
Telephone Number	:	907-268-7533

Provider Enumeration Date	:	03/10/2022
Last Update Date	:	04/21/2022

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Directions to “AURORA PEDIATRIC THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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