Healthcare Provider Details

I. General information

NPI: 1952409104
Provider Name (Legal Business Name): CAROLYN MARIE JUNTA P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/09/2007
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 Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0213
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: