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NPI Code Detail

MEDICARE: PRISM PT LLC

MEDICARE: PRISM PT 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 Therapist

General Provider Information

NPI Number : 1992339824
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRISM PT LLC
Provider Business Mailing Address
First Line : 7575 W WASHINGTON AVE STE 127-140
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4333
Country : US
Telephone Number : 702-796-8849
Fax Number : 702-796-6310
Provider Business Practice Location Address
First Line : 6823 PONDEROSA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2100
Country : US
Telephone Number : 702-338-2533
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SCOTT R PENSIVY
Credential : PT
Telephone Number : 702-338-2533
Provider Enumeration Date : 02/29/2020
Last Update Date : 02/29/2020

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Directions to “PRISM PT LLC ” Practice Location

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