MEDICARE: DAVID TIMOTHY TATLOCK PT

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	174400000X	Specialist	1805	NV

General Provider Information

NPI Number	:	1932370277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID TIMOTHY TATLOCK PT

Provider Business Mailing Address
First Line	:	5228 JOSE ERNESTO ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7951
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5228 JOSE ERNESTO ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7951
Country	:	US
Telephone Number	:	702-731-0831
Fax Number	:	702-737-9697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	03/14/2008

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Directions to “ DAVID TIMOTHY TATLOCK PT” Practice Location

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