Healthcare Provider Details

I. General information

NPI: 1912885534
Provider Name (Legal Business Name): HEATHER SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 PASEO VERDE PKWY STE 115
HENDERSON NV
89074-7121
US

IV. Provider business mailing address

10845 EDGESTONE AVE
LAS VEGAS NV
89166-1230
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-4009
  • Fax:
Mailing address:
  • Phone: 702-521-0437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1635
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: