Healthcare Provider Details

I. General information

NPI: 1780074955
Provider Name (Legal Business Name): KAT'S PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 N RAINBOW BLVD #A60
LAS VEGAS NV
89107-1103
US

IV. Provider business mailing address

848 N RAINBOW BLVD #A60
LAS VEGAS NV
89107-1103
US

V. Phone/Fax

Practice location:
  • Phone: 702-219-1660
  • Fax:
Mailing address:
  • Phone: 702-219-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1524
License Number StateNV

VIII. Authorized Official

Name: KATHERINE GRACE BERNARDO
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 702-219-1660