Healthcare Provider Details

I. General information

NPI: 1811194533
Provider Name (Legal Business Name): NEVADA TENDONITIS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 VILLAGE WALK DR SUITE 280
HENDERSON NV
89052-5679
US

IV. Provider business mailing address

2225 VILLAGE WALK DR SUITE 280
HENDERSON NV
89052-5679
US

V. Phone/Fax

Practice location:
  • Phone: 702-617-2995
  • Fax:
Mailing address:
  • Phone: 702-617-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRUCE HANDELMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 702-617-2995