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General NPI Number Information
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NPI Number | 1073839536
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Entity Type | Organization
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Legal Business Name | MGML, INC.
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 04/08/2010
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Provider Practice Location Address
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Address Line | 8534 BENIDORM AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-4806
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Country | US
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Telephone | 702-354-5478
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Fax | 702-458-3824
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Provider Business Mailing Address
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Address Line | 8534 BENIDORM AVE
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City | LAS VEGAS
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State | NV
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Zip | 89178-4806
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Country | US
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Telephone | 702-354-5478
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Fax | 702-458-3824
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE GAY MANGALIAG LIM
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Credential | P.T.
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Telephone | 702-354-5478
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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 | 1689
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License Number State | NV
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