Healthcare Provider Details

I. General information

NPI: 1851332720
Provider Name (Legal Business Name): FIRST PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 10/19/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5785 CENTENNIAL CENTER BLVD STE 220
LAS VEGAS NV
89149-7111
US

IV. Provider business mailing address

5785 CENTENNIAL CENTER BLVD STE 220
LAS VEGAS NV
89149-7111
US

V. Phone/Fax

Practice location:
  • Phone: 702-916-2777
  • Fax: 702-916-2778
Mailing address:
  • Phone: 702-916-2777
  • Fax: 702-916-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007711
License Number StateNV

VIII. Authorized Official

Name: MEAGAN E GRIMALDO
Title or Position: OWNER
Credential:
Phone: 702-916-2777