Healthcare Provider Details

I. General information

NPI: 1063148377
Provider Name (Legal Business Name): THERAPY ACHIEVEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

IV. Provider business mailing address

8670 W CHEYENNE AVE STE 110
LAS VEGAS NV
89129-7457
US

V. Phone/Fax

Practice location:
  • Phone: 725-202-1497
  • Fax: 725-202-1500
Mailing address:
  • Phone: 725-202-1497
  • Fax: 725-202-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN MANVELL
Title or Position: OWNER / SLP
Credential: PRESIDENT,OWNER,SLP
Phone: 714-943-7146