Healthcare Provider Details

I. General information

NPI: 1902722903
Provider Name (Legal Business Name): SUMMIT WELLNESS OF DPSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 S JONES BLVD STE 201
LAS VEGAS NV
89107-2680
US

IV. Provider business mailing address

3909 S MARYLAND PKWY STE 314
LAS VEGAS NV
89119-7520
US

V. Phone/Fax

Practice location:
  • Phone: 725-302-5780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: NICK GYWN
Title or Position: COO
Credential:
Phone: 725-302-5780