Healthcare Provider Details

I. General information

NPI: 1538151535
Provider Name (Legal Business Name): RENO PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N WEST ST
FERNLEY NV
89408-9799
US

IV. Provider business mailing address

PO BOX 511
FERNLEY NV
89408-0511
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-5508
  • Fax: 775-575-6655
Mailing address:
  • Phone: 775-575-5508
  • Fax: 775-575-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0016, 0441,1242,1523
License Number StateNV

VIII. Authorized Official

Name: MRS. BRIDGETTE LESAR
Title or Position: PRESIDENT
Credential: PT
Phone: 775-575-5508