Healthcare Provider Details

I. General information

NPI: 1871794420
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7361 PRAIRIE FALCON RD STE 130
LAS VEGAS NV
89128
US

IV. Provider business mailing address

6263 POPLAR AVE STE 801
MEMHIS TN
38119-4701
US

V. Phone/Fax

Practice location:
  • Phone: 702-804-1511
  • Fax: 702-804-2551
Mailing address:
  • Phone: 901-685-7227
  • Fax: 267-321-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TARVIN
Title or Position: VICE PRESIDENT
Credential:
Phone: 717-972-1100