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General NPI Number Information
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NPI Number | 1598162018
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Entity Type | Individual
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Provider Name | MICHAEL ANDERSON
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Gender | Male
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 3737 PECOS MCLEOD
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City | LAS VEGAS
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State | NV
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Zip | 89121-4262
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Country | US
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Telephone | 702-433-3038
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Fax | 702-433-2210
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Provider Business Mailing Address
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Address Line | 3737 PECOS MCLEOD
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City | LAS VEGAS
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State | NV
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Zip | 89121-4262
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Country | US
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Telephone | 702-433-3038
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Fax | 702-433-2210
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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