MEDICARE: FIRST PHYSICAL THERAPY 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
1	261QP2000X	Physical Therapy Clinic/Center
2	225100000X	Physical Therapist	007711	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851332720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	5785 CENTENNIAL CENTER BLVD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-7111
Country	:	US
Telephone Number	:	702-916-2777
Fax Number	:	702-916-2778

Provider Business Practice Location Address
First Line	:	5785 CENTENNIAL CENTER BLVD STE 220
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-7111
Country	:	US
Telephone Number	:	702-916-2777
Fax Number	:	702-916-2778

Authorized Official
Title or Position	:	OWNER
Name	:	MEAGAN E GRIMALDO
Credential	:
Telephone Number	:	702-916-2777

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	10/19/2023

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Directions to “FIRST PHYSICAL THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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