Healthcare Provider Details

I. General information

NPI: 1497810576
Provider Name (Legal Business Name): MY LEFT FOOT CHILDREN'S THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S. JONES BLVD
LAS VEGAS NV
89146
US

IV. Provider business mailing address

3395 S. JONES BLVD #363
LAS VEGAS NV
89146
US

V. Phone/Fax

Practice location:
  • Phone: 702-360-1137
  • Fax: 702-341-1511
Mailing address:
  • Phone: 702-360-1137
  • Fax: 702-341-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JON GOTTLIEB
Title or Position: OWNER
Credential:
Phone: 702-360-1137