Healthcare Provider Details

I. General information

NPI: 1164524625
Provider Name (Legal Business Name): RICHARD L BALES PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 10/24/2021
Certification Date: 10/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E FLAMINGO RD STE 314
LAS VEGAS NV
89119-5193
US

IV. Provider business mailing address

2421 GOLDFIRE CIR
HENDERSON NV
89052-2667
US

V. Phone/Fax

Practice location:
  • Phone: 702-947-5200
  • Fax: 702-947-5204
Mailing address:
  • Phone: 702-947-5200
  • Fax: 702-947-5204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number252
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0252
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: