=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841126059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY JOANNE NOVA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2026
-----------------------------------------------------
Last Update Date | 06/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7125 GRAND MONTECITO PKWY STE 120
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89149-0261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-515-1540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7332 YOUNG DOE AVE
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89130-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-557-1530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | A-1890
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------