MEDICARE: ATHLETES' PERFORMANCE LAS VEGAS 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

General Provider Information

NPI Number	:	1134281165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHLETES' PERFORMANCE LAS VEGAS LLC

Provider Business Mailing Address
First Line	:	2730 S RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6400
Country	:	US
Telephone Number	:	702-257-8911
Fax Number	:	702-257-9411

Provider Business Practice Location Address
First Line	:	2730 S RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-6400
Country	:	US
Telephone Number	:	702-257-8911
Fax Number	:	702-257-9411

Authorized Official
Title or Position	:	BILLER
Name	:	MRS. JILL MAYER
Credential	:
Telephone Number	:	480-626-4589

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	08/22/2020

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Directions to “ATHLETES' PERFORMANCE LAS VEGAS LLC ” Practice Location

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