Healthcare Provider Details

I. General information

NPI: 1841126059
Provider Name (Legal Business Name): AMY JOANNE NOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7125 GRAND MONTECITO PKWY STE 120
LAS VEGAS NV
89149-0261
US

IV. Provider business mailing address

7332 YOUNG DOE AVE
LAS VEGAS NV
89130-7935
US

V. Phone/Fax

Practice location:
  • Phone: 702-515-1540
  • Fax:
Mailing address:
  • Phone: 702-557-1530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1890
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: