Healthcare Provider Details

I. General information

NPI: 1912587817
Provider Name (Legal Business Name): ADVANCED PEDIATRIC THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 E PRATER WAY STE 107
SPARKS NV
89434-8963
US

IV. Provider business mailing address

1625 E PRATER WAY STE 107
SPARKS NV
89434-8963
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-4744
  • Fax: 775-351-1644
Mailing address:
  • Phone: 775-825-4744
  • Fax: 775-351-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN BAKER
Title or Position: OFFICE MANAGER
Credential:
Phone: 775-825-4744