Healthcare Provider Details

I. General information

NPI: 1225133903
Provider Name (Legal Business Name): TONY K IWAKAWA D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 W. HORIZON RIDGE PKWY SUITE 205
HENDERSON NV
89052
US

IV. Provider business mailing address

2930 W. HORIZON RIDGE PKWY SUITE 205
HENDERSON NV
89052
US

V. Phone/Fax

Practice location:
  • Phone: 702-597-8999
  • Fax: 702-597-8988
Mailing address:
  • Phone: 702-597-8999
  • Fax: 702-597-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1961
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: