Healthcare Provider Details

I. General information

NPI: 1659472199
Provider Name (Legal Business Name): VEGAS VALLEY REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N RAINBOW BLVD SUITE 115
LAS VEGAS NV
89107-1082
US

IV. Provider business mailing address

500 N RAINBOW BLVD SUITE 115
LAS VEGAS NV
89107-1082
US

V. Phone/Fax

Practice location:
  • Phone: 702-256-8080
  • Fax: 702-256-8081
Mailing address:
  • Phone: 702-256-8080
  • Fax: 702-256-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1951
License Number StateNV

VIII. Authorized Official

Name: BARRIE JILL MINADEO-KNUTSON
Title or Position: OFFICE MANAGER
Credential: CMA-A
Phone: 702-256-8080