Healthcare Provider Details

I. General information

NPI: 1437878873
Provider Name (Legal Business Name): ERIKA JADE MARIGLIANO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8402 CENTENNIAL PKWY STE 240
LAS VEGAS NV
89149-4793
US

IV. Provider business mailing address

8402 CENTENNIAL PKWY STE 240
LAS VEGAS NV
89149-4793
US

V. Phone/Fax

Practice location:
  • Phone: 702-294-7499
  • Fax: 702-294-7494
Mailing address:
  • Phone: 702-294-7499
  • Fax: 702-294-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5036
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number302770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: