Healthcare Provider Details

I. General information

NPI: 1346622719
Provider Name (Legal Business Name): BEYOND BOUNDARIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 PAINTED MIRAGE RD SUITE 320
LAS VEGAS NV
89149-4581
US

IV. Provider business mailing address

5550 PAINTED MIRAGE RD SUITE 320
LAS VEGAS NV
89149-4581
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-0774
  • Fax: 702-834-3256
Mailing address:
  • Phone: 702-444-0774
  • Fax: 702-834-3256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14-0449
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2971
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number14-0530
License Number StateNV

VIII. Authorized Official

Name: MRS. JENNIFER WEAVER
Title or Position: MEMBER
Credential: OTR/L
Phone: 978-302-9529