Healthcare Provider Details

I. General information

NPI: 1912818683
Provider Name (Legal Business Name): ELIJAH JUSTIN G SAPICO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 DOUBLE DIAMOND PKWY
RENO NV
89521-5845
US

IV. Provider business mailing address

9480 DOUBLE DIAMOND PKWY
RENO NV
89521-5845
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberA-1336
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: