Healthcare Provider Details

I. General information

NPI: 1760367528
Provider Name (Legal Business Name): SAINT K GELACIO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7399 S JONES BLVD STE A5-A6
LAS VEGAS NV
89139-5554
US

IV. Provider business mailing address

7399 S JONES BLVD STE A5-A6
LAS VEGAS NV
89139-5554
US

V. Phone/Fax

Practice location:
  • Phone: 172-523-1783
  • Fax:
Mailing address:
  • Phone: 725-231-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6809
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: