MEDICARE: MY LEFT FOOT CHILDREN'S THERAPY, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	224Z00000X	Occupational Therapy Assistant
2	225100000X	Physical Therapist
3	225200000X	Physical Therapy Assistant
4	225X00000X	Occupational Therapist
5	235Z00000X	Speech-Language Pathologist
6	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1790080463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY LEFT FOOT CHILDREN'S THERAPY, LLC.

Provider Business Mailing Address
First Line	:	3395 S JONES BLVD # 363
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6729
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:	702-240-1729

Provider Business Practice Location Address
First Line	:	2012 S JONES BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-3151
Country	:	US
Telephone Number	:	702-360-1137
Fax Number	:	702-240-1729

Authorized Official
Title or Position	:	COO
Name	:	JON GOTTLIEB
Credential	:
Telephone Number	:	702-360-1137

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	05/13/2016

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