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General NPI Number Information
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NPI Number | 1245078138
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Entity Type | Organization
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Legal Business Name | BENGOA PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/16/2024
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 100 CARSON RD STE B
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City | BATTLE MOUNTAIN
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State | NV
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Zip | 89820-2311
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Country | US
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Telephone | 775-455-0049
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Fax | 775-539-3234
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Provider Business Mailing Address
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Address Line | 100 CARSON RD STE B
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City | BATTLE MOUNTAIN
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State | NV
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Zip | 89820-2311
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Country | US
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Telephone | 775-455-0049
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Fax |
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Authorized Official
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Title or Position | PT/MANAGING MEMBER
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Name | MARY BENGOA
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Credential | PT, MS
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Telephone | 775-455-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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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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