MEDICARE: STEPHANIE NEWBURY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A-0720	NV

General Provider Information

NPI Number	:	1013430917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NEWBURY PTA

Provider Business Mailing Address
First Line	:	6772 BRISTLE FALLS ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6650 GRAND MONTECITO PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0210
Country	:	US
Telephone Number	:	702-333-1290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2017
Last Update Date	:	07/23/2017

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