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General NPI Number Information
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NPI Number | 1528736295
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Entity Type | Organization
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Legal Business Name | ON THE ROLL PT, LLC
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 10462 VIOLET PEARL ST
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City | LAS VEGAS
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State | NV
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Zip | 89183-7986
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Country | US
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Telephone | 323-553-7655
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 VIA CASSIA
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City | HENDERSON
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State | NV
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Zip | 89052-4122
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Country | US
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Telephone | 402-960-6719
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIRA MARKUS
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Credential | DPT
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Telephone | 402-960-6719
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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