=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326629627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOLIOSIS BASICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2021
-----------------------------------------------------
Last Update Date | 04/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8301 W FLAMINGO RD APT 1037
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-219-9847
-----------------------------------------------------
Fax | 833-696-0789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8301 W FLAMINGO RD APT 1037
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89147-4137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 862-219-9847
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. DENNIS GUTIERREZ
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 908-224-4252
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------