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General NPI Number Information
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NPI Number | 1912082140
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Entity Type | Organization
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Legal Business Name | FAMILY AND SPORTS PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 7351 PRAIRIE FALCON RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-0820
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Country | US
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Telephone | 702-968-0520
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Fax | 702-968-0521
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Provider Business Mailing Address
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Address Line | 7351 PRAIRIE FALCON RD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-0820
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Country | US
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Telephone | 702-968-0520
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Fax | 702-968-0521
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Authorized Official
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Title or Position | DIRECTOR, SECRETARY
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Name | MR. JEFF DIETRICH
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Credential | PT
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Telephone | 702-968-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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