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General NPI Number Information
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NPI Number | 1053918185
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Entity Type | Organization
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Legal Business Name | KIME PERFORMANCE NEVADA LLC
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Dates
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Enumeration Date | 10/01/2020
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 5301 LONGLEY LN STE 81
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City | RENO
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State | NV
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Zip | 89511-1868
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Country | US
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Telephone | 916-905-6378
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 LONGLEY LN STE 81
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City | RENO
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State | NV
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Zip | 89511-1868
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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 | CEO
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Name | ANTHONY R MIKLA
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Credential | PT
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Telephone | 916-342-4190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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