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General NPI Number Information
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NPI Number | 1982947701
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Entity Type | Organization
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Legal Business Name | A-GRAV 1 LLC
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Dates
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Enumeration Date | 03/29/2013
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 365 E WINDMILL LN
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City | LAS VEGAS
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State | NV
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Zip | 89123-1807
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Country | US
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Telephone | 702-675-3569
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Fax | 702-701-9413
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Provider Business Mailing Address
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Address Line | 2375 E TROPICANA AVE # 271
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City | LAS VEGAS
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State | NV
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Zip | 89119-6564
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Country | US
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Telephone | 702-675-3569
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Fax | 702-701-9413
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. DENNIS LAVERN DUBOIS
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Credential |
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Telephone | 702-373-8151
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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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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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