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General NPI Number Information
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NPI Number | 1427543081
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Entity Type | Organization
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Legal Business Name | PHYSIOSPINE RENO, LLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 6880 S MCCARRAN BLVD STE 13
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City | RENO
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State | NV
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Zip | 89509-6129
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Country | US
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Telephone | 775-399-4094
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Fax | 775-201-6613
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Provider Business Mailing Address
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Address Line | 6880 S MCCARRAN BLVD STE 13
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City | RENO
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State | NV
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Zip | 89509-6129
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Country | US
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Telephone | 775-399-4094
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Fax | 775-201-6613
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Authorized Official
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Title or Position | OWNER/MANGING MEMBER
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Name | BRIAN THOMAS WESSEL
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Credential | MPT
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Telephone | 775-399-4094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 3702
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License Number State | NV
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