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General NPI Number Information
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NPI Number | 1386871630
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Entity Type | Organization
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Legal Business Name | DYNAMIC SPINE & SPORT REHABILITATION LLC
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Dates
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Enumeration Date | 06/14/2009
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 8951 W SAHARA AVE SUITE 190
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City | LAS VEGAS
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State | NV
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Zip | 89117-5898
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Country | US
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Telephone | 702-808-4943
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Fax | 702-968-8637
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Provider Business Mailing Address
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Address Line | 8951 W SAHARA AVE STE 190
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City | LAS VEGAS
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State | NV
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Zip | 89117-5899
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Country | US
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Telephone | 702-685-1607
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Fax | 702-685-1506
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Authorized Official
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Title or Position | OWNER
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Name | JOE INDRIERI
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Credential | PT
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Telephone | 702-685-1607
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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 | 1815
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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