Healthcare Provider Details

I. General information

NPI: 1073099222
Provider Name (Legal Business Name): REX AGBAYANI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W WARM SPRINGS RD
HENDERSON NV
89014-3586
US

IV. Provider business mailing address

1500 W WARM SPRINGS RD
HENDERSON NV
89014-3586
US

V. Phone/Fax

Practice location:
  • Phone: 702-547-2041
  • Fax:
Mailing address:
  • Phone: 702-547-2041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3068
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: