Healthcare Provider Details

I. General information

NPI: 1770582462
Provider Name (Legal Business Name): TREVOR A OFFENBACKER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E CALVADA BLVD
PAHRUMP NV
89048-3974
US

IV. Provider business mailing address

3602 E SUNSET RD LAS VEGAS
LAS VEGAS NV
89120-7202
US

V. Phone/Fax

Practice location:
  • Phone: 775-727-4700
  • Fax: 775-727-7970
Mailing address:
  • Phone: 702-932-4308
  • Fax: 702-837-8930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1010
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: