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General NPI Number Information
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NPI Number | 1891070934
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Entity Type | Organization
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Legal Business Name | THI OF NEVADA AT DESERT VALLEY THERAPY LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 1701 N GREEN VALLEY PKWY BLDG 8 SUITE B
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City | HENDERSON
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State | NV
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Zip | 89074-5885
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Country | US
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Telephone | 702-998-3333
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Fax | 702-260-4051
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Provider Business Mailing Address
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Address Line | 920 RIDGEBROOK RD
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City | SPARKS
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State | MD
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Zip | 21152-9390
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LUKE GAUGHAN
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Credential |
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Telephone | 702-998-3333
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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 |
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License Number State |
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