MEDICARE: DR. MARK RIZKALLA PT, DPT

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	225100000X	Physical Therapist	3466	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023554748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK RIZKALLA PT, DPT

Provider Business Mailing Address
First Line	:	600 S TONOPAH DR STE 350
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4040
Country	:	US
Telephone Number	:	702-384-6330
Fax Number	:	702-384-2668

Provider Business Practice Location Address
First Line	:	1815 E LAKE MEAD BLVD STE 200
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-7189
Country	:	US
Telephone Number	:	702-685-0440
Fax Number	:	702-974-6717

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/22/2019

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