Healthcare Provider Details

I. General information

NPI: 1205838265
Provider Name (Legal Business Name): MARCHANT PHYSICAL THERAPY & WELLNESS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 FALCON RIDGE PARKWAY BUILDING 500
MESQUITE NV
89027
US

IV. Provider business mailing address

PO BOX 69
MESQUITE NV
89024-0069
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-3105
  • Fax: 702-346-3544
Mailing address:
  • Phone: 702-346-3105
  • Fax: 703-346-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number78602
License Number StateNV

VIII. Authorized Official

Name: BOBBY ISMAIL
Title or Position: PRESIDENT
Credential: DPT
Phone: 209-353-1988