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General NPI Number Information
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NPI Number | 1821262031
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Entity Type | Organization
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Legal Business Name | WILDCREEK PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 2255 GREEN VISTA DR STE. 401
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City | SPARKS
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State | NV
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Zip | 89431-8534
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Country | US
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Telephone | 775-673-9700
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Fax | 775-673-9799
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Provider Business Mailing Address
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Address Line | 2255 GREEN VISTA DR STE. 401
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City | SPARKS
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State | NV
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Zip | 89431-8534
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Country | US
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Telephone | 775-673-9700
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Fax | 775-673-9799
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Authorized Official
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Title or Position | CEO
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Name | MS. CAROLYN MARIE JUNTA
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Credential | P.T.
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Telephone | 775-673-9700
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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 | NV213
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License Number State | NV
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