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General NPI Number Information
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NPI Number | 1275022642
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Entity Type | Individual
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Provider Name | ANDREW FENTON
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Gender | Male
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Dates
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Enumeration Date | 05/01/2018
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Last Update Date | 05/01/2018
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Provider Practice Location Address
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Address Line | 6900 N PECOS RD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89086-4400
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Country | US
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Telephone | 702-731-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 7452 POPPY HILLS CT
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City | LAS VEGAS
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State | NV
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Zip | 89113-3236
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Country | US
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Telephone | 719-510-8828
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-2011
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License Number State | NV
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