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General NPI Number Information
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NPI Number | 1023771524
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Entity Type | Individual
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Provider Name | RYAN LAPAZ BACANI
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Gender | Male
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1701 N GREEN VALLEY PKWY STE B
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City | HENDERSON
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State | NV
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Zip | 89074-5885
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Country | US
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Telephone | 702-998-3333
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Fax | 702-260-4051
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Provider Business Mailing Address
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Address Line | 790 REMINGTON BLVD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-4909
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | NY
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