Healthcare Provider Details

I. General information

NPI: 1952597049
Provider Name (Legal Business Name): TAVENER J STREIT D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6630 S MCCARRAN BLVD SUITE A-6
RENO NV
89509-6135
US

IV. Provider business mailing address

6630 S MCCARRAN BLVD SUITE A-6
RENO NV
89509-6135
US

V. Phone/Fax

Practice location:
  • Phone: 775-828-2866
  • Fax: 775-828-2891
Mailing address:
  • Phone: 775-828-2866
  • Fax: 775-828-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2178
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: