Healthcare Provider Details

I. General information

NPI: 1356967939
Provider Name (Legal Business Name): SALVATORE A BIUNDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2860 E CHEYENNE AVE
LAS VEGAS NV
89121
US

IV. Provider business mailing address

3213 W CHARLESTON BLVD STE 105
LAS VEGAS NV
89102-1991
US

V. Phone/Fax

Practice location:
  • Phone: 702-644-7777
  • Fax:
Mailing address:
  • Phone: 702-570-6222
  • Fax: 702-224-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number4206
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: