Healthcare Provider Details

I. General information

NPI: 1275908857
Provider Name (Legal Business Name): ADAM J JAVATE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 10/09/2022
Certification Date: 10/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10895 S EASTERN AVE STE 120
HENDERSON NV
89052-5852
US

IV. Provider business mailing address

10895 S EASTERN AVE STE 120
HENDERSON NV
89052-5852
US

V. Phone/Fax

Practice location:
  • Phone: 725-204-1016
  • Fax: 725-204-6572
Mailing address:
  • Phone: 725-204-1016
  • Fax: 725-204-6572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4349
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number43315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: