=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235981184
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIERRA THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2024
-----------------------------------------------------
Last Update Date | 05/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1324 DISC DR
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-0684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-384-1224
-----------------------------------------------------
Fax | 775-360-6206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1324 DISC DR
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89436-0684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-684-1224
-----------------------------------------------------
Fax | 775-360-6206
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CHRISTINE JANE BUESNEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 650-296-6362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------