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General NPI Number Information
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NPI Number | 1508475203
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Entity Type | Organization
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Legal Business Name | POWERHOUSE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 3050 E BONANZA RD STE 110D
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City | LAS VEGAS
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State | NV
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Zip | 89101-3706
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Country | US
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Telephone | 201-388-7082
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 E BONANZA RD STE 110D
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City | LAS VEGAS
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State | NV
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Zip | 89101-3706
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Country | US
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Telephone | 201-388-7082
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BRANDON SCOTT RESASCO
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Credential |
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Telephone | 201-388-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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