MEDICARE: ADVANCED MANUAL THERAPY INSTITUTE I LLC

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	1719	NV
2	225X00000X	Occupational Therapist	0662	NV
3	225X00000X	Occupational Therapist	0663	NV
4	225100000X	Physical Therapist	1735	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTAN	OTHER	NV	V101390
2	V101389	OTHER	NV	PTAN
3	V101391	OTHER	NV	PTAN
4	V101393	OTHER	NV	PTAN
5	V101392	OTHER	NV	PTAN

General Provider Information

NPI Number	:	1023558426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED MANUAL THERAPY INSTITUTE I LLC

Provider Business Mailing Address
First Line	:	2625 W HORIZON RIDGE PKWY
Second Line	:	SUITE 120
City	:	HENDERSON
State	:	NV
Zip	:	89052-2896
Country	:	US
Telephone Number	:	702-896-0383
Fax Number	:	702-889-0383

Provider Business Practice Location Address
First Line	:	6424 LOSEE RD
Second Line	:	SUITE 120
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-0101
Country	:	US
Telephone Number	:	702-896-0383
Fax Number	:	702-889-0383

Authorized Official
Title or Position	:	OWNER
Name	:	MICHEL RANTISSI
Credential	:	DPT, MOT, MTC
Telephone Number	:	702-896-0383

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	03/03/2017

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Directions to “ADVANCED MANUAL THERAPY INSTITUTE I LLC ” Practice Location

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