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NPI Code Detail

MEDICARE: ADVANCED MANUEL THERAPY INSTITUTE 1 LLC

MEDICARE: ADVANCED MANUEL THERAPY INSTITUTE 1 LLC
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 Therapist1719NV
2225X00000XOccupational Therapist0662NV
3225X00000XOccupational Therapist0663NV
4225100000XPhysical Therapist1735NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V101390OTHERNVPTAN
2V101391OTHERNVPTAN
3V101389OTHERNVPTAN
4V101392OTHERNVPTAN
5V101393OTHERNVPTAN

General Provider Information

NPI Number : 1801086053
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED MANUEL THERAPY INSTITUTE 1 LLC
Provider Business Mailing Address
First Line : 2625 W HORIZON RIDGE PKWY
Second Line : #120
City : HENDERSON
State : NV
Zip : 89052-2896
Country : US
Telephone Number : 702-896-0383
Fax Number : 702-889-0383
Provider Business Practice Location Address
First Line : 911 N BUFFALO DR
Second Line : #107
City : LAS VEGAS
State : NV
Zip : 89128-0379
Country : US
Telephone Number : 702-896-0383
Fax Number : 702-889-0383
Authorized Official
Title or Position : OWNER
Name : MR. MICHEL S RANTISSI JR.
Credential : DPT, MOT, MTC
Telephone Number : 702-896-0383
Provider Enumeration Date : 07/25/2007
Last Update Date : 06/17/2013

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Directions to “ADVANCED MANUEL THERAPY INSTITUTE 1 LLC ” Practice Location

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