Healthcare Provider Details

I. General information

NPI: 1427543081
Provider Name (Legal Business Name): PHYSIOSPINE RENO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6880 S MCCARRAN BLVD STE 13
RENO NV
89509-6129
US

IV. Provider business mailing address

6880 S MCCARRAN BLVD STE 13
RENO NV
89509-6129
US

V. Phone/Fax

Practice location:
  • Phone: 775-399-4094
  • Fax: 775-201-6613
Mailing address:
  • Phone: 775-399-4094
  • Fax: 775-201-6613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3702
License Number StateNV

VIII. Authorized Official

Name: BRIAN THOMAS WESSEL
Title or Position: OWNER/MANGING MEMBER
Credential: MPT
Phone: 775-399-4094