=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427860717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ETHAN THOMAS FORBES PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1610 ROBB DR STE D5
-----------------------------------------------------
City | RENO
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89523-3520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-746-9222
-----------------------------------------------------
Fax | 775-746-9224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1450 E PRATER WAY STE 103
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89434-8973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-746-9222
-----------------------------------------------------
Fax | 775-746-9224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 6922
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------