Healthcare Provider Details

I. General information

NPI: 1922928704
Provider Name (Legal Business Name): MICHAEL PAUL PLAZA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5765 S RAINBOW BLVD STE 111
LAS VEGAS NV
89118-2537
US

IV. Provider business mailing address

5765 S RAINBOW BLVD STE 111
LAS VEGAS NV
89118-2537
US

V. Phone/Fax

Practice location:
  • Phone: 725-726-7914
  • Fax:
Mailing address:
  • Phone: 725-726-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1519
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: