MEDICARE: NICHOLAS LANGENEGGER 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-1713	NV

General Provider Information

NPI Number	:	1063351153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS LANGENEGGER PTA

Provider Business Mailing Address
First Line	:	8060 S RAINBOW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6487
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8060 S RAINBOW BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-6487
Country	:	US
Telephone Number	:	702-560-9223
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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Directions to “ NICHOLAS LANGENEGGER PTA” Practice Location

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