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General NPI Number Information
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NPI Number | 1801086053
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Entity Type | Organization
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Legal Business Name | ADVANCED MANUEL THERAPY INSTITUTE 1 LLC
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 911 N BUFFALO DR #107
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City | LAS VEGAS
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State | NV
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Zip | 89128-0379
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Country | US
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Telephone | 702-896-0383
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Fax | 702-889-0383
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Provider Business Mailing Address
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Address Line | 2625 W HORIZON RIDGE PKWY #120
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City | HENDERSON
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State | NV
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Zip | 89052-2896
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Country | US
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Telephone | 702-896-0383
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Fax | 702-889-0383
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Authorized Official
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Title or Position | OWNER
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Name | MR. MICHEL S RANTISSI JR.
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Credential | DPT, MOT, MTC
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Telephone | 702-896-0383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1719
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0662
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 0663
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1735
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License Number State | NV
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