Healthcare Provider Details

I. General information

NPI: 1558592493
Provider Name (Legal Business Name): GOOD SHEPHERD REHABILITATION RESEARCH INSTITUTE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W. WASHINGTON AVE. SUITE# 185
LAS VEGAS NV
89128
US

IV. Provider business mailing address

P.O. BOX 26299
LAS VEGAS NV
89126
US

V. Phone/Fax

Practice location:
  • Phone: 702-893-3333
  • Fax: 702-893-0960
Mailing address:
  • Phone: 702-893-3333
  • Fax: 702-893-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number1006252924
License Number StateNV

VIII. Authorized Official

Name: MR. RAUL A. ABEJUELA
Title or Position: PRESIDENT
Credential:
Phone: 702-893-3333