Healthcare Provider Details

I. General information

NPI: 1962358416
Provider Name (Legal Business Name): MARTHA S PROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10348 CHERRY BROOK ST
LAS VEGAS NV
89183-6996
US

IV. Provider business mailing address

10348 CHERRY BROOK ST
LAS VEGAS NV
89183-6996
US

V. Phone/Fax

Practice location:
  • Phone: 413-768-4932
  • Fax:
Mailing address:
  • Phone: 413-768-4932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1462
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: