MEDICARE: EDUCATED ATHLETICS LTD.

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1134893142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDUCATED ATHLETICS LTD.

Provider Business Mailing Address
First Line	:	7044 PARROT BAY WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4748
Country	:	US
Telephone Number	:	949-701-6722
Fax Number	:

Provider Business Practice Location Address
First Line	:	7044 PARROT BAY WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-4748
Country	:	US
Telephone Number	:	949-701-6722
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TAYLOR KUCERA
Credential	:	DPT
Telephone Number	:	949-701-6722

Provider Enumeration Date	:	08/03/2021
Last Update Date	:	08/03/2021

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