Healthcare Provider Details

I. General information

NPI: 1821262031
Provider Name (Legal Business Name): WILDCREEK PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 GREEN VISTA DR STE. 401
SPARKS NV
89431-8534
US

IV. Provider business mailing address

2255 GREEN VISTA DR STE. 401
SPARKS NV
89431-8534
US

V. Phone/Fax

Practice location:
  • Phone: 775-673-9700
  • Fax: 775-673-9799
Mailing address:
  • Phone: 775-673-9700
  • Fax: 775-673-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNV213
License Number StateNV

VIII. Authorized Official

Name: MS. CAROLYN MARIE JUNTA
Title or Position: CEO
Credential: P.T.
Phone: 775-673-9700