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General NPI Number Information
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NPI Number | 1790095586
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Entity Type | Organization
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Legal Business Name | DESERT MEDICAL REHAB LLC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 3555 W RENO AVE SUITE F
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City | LAS VEGAS
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State | NV
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Zip | 89118-1609
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Country | US
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Telephone | 702-876-9171
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Fax | 702-876-9083
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Provider Business Mailing Address
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Address Line | 3555 W RENO AVE SUITE F
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City | LAS VEGAS
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State | NV
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Zip | 89118-1609
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Country | US
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Telephone | 702-876-9171
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Fax | 702-876-9083
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRYAN SCHULTZ
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Credential |
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Telephone | 702-876-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 20131609510
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License Number State | NV
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