Healthcare Provider Details

I. General information

NPI: 1720071574
Provider Name (Legal Business Name): PATRICK MCGUIRE HUTT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 BUSINESS PARK CT STE 100
LAS VEGAS NV
89128-9018
US

IV. Provider business mailing address

3831 W CHARLESTON BLVD
LAS VEGAS NV
89102-1859
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-6978
  • Fax: 702-869-6959
Mailing address:
  • Phone: 702-876-1733
  • Fax: 702-878-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1117
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: