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General NPI Number Information
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NPI Number | 1649037557
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Entity Type | Organization
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Legal Business Name | ON ICE ATHLETICS LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/06/2024
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Provider Practice Location Address
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Address Line | 1550 S PAVILION CENTER DR
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City | LAS VEGAS
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State | NV
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Zip | 89135-2964
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Country | US
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Telephone | 970-391-6408
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Fax |
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Provider Business Mailing Address
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Address Line | 7260 W AZURE DR STE 140-58
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City | LAS VEGAS
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State | NV
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Zip | 89130-7999
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Country | US
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Telephone | 970-391-6408
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KENDELL SARAH GALOR
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Credential | MS, LAT, ATC, CSCS
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Telephone | 970-391-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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