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NPI Code Detail

MEDICARE: CONNER PENSIVY DR.

MEDICARE: CONNER PENSIVY DR.
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 Therapist6241NV

General Provider Information

NPI Number : 1861276149
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNER PENSIVY DR.
Provider Business Mailing Address
First Line : 6823 PONDEROSA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2100
Country : US
Telephone Number : 702-665-4054
Fax Number :
Provider Business Practice Location Address
First Line : 6823 PONDEROSA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2100
Country : US
Telephone Number : 702-665-4054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2023
Last Update Date : 08/21/2023

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Directions to “ CONNER PENSIVY DR.” Practice Location

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