Healthcare Provider Details

I. General information

NPI: 1851557771
Provider Name (Legal Business Name): PDS THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 W ANN RD 130-407
LAS VEGAS NV
89130-3865
US

IV. Provider business mailing address

7065 W ANN RD 130-407
LAS VEGAS NV
89130-3865
US

V. Phone/Fax

Practice location:
  • Phone: 702-448-4200
  • Fax: 702-448-4200
Mailing address:
  • Phone: 702-448-4200
  • Fax: 702-448-4200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHELLY PAIGE OLIVADOTI-SANTORO
Title or Position: CO-PRESIDENT
Credential: PT
Phone: 702-448-4200