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NPI Code Detail

MEDICARE: BRYAN REYNON GANITANO

MEDICARE: BRYAN REYNON GANITANO
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
1225200000XPhysical Therapy AssistantA-0788NV

General Provider Information

NPI Number : 1871167064
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRYAN REYNON GANITANO
Provider Business Mailing Address
First Line : 1537 SABATINI DR
Second Line :
City : HENDERSON
State : NV
Zip : 89052-4126
Country : US
Telephone Number : 702-498-1077
Fax Number :
Provider Business Practice Location Address
First Line : 2080 E FLAMINGO RD STE 111
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-5175
Country : US
Telephone Number : 702-737-8820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2021
Last Update Date : 05/13/2021

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Directions to “ BRYAN REYNON GANITANO ” Practice Location

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