MEDICARE: UNLV-USC 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	:	1154790012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLV-USC LLC

Provider Business Mailing Address
First Line	:	9310 SUN CITY BLVD
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-1705
Country	:	US
Telephone Number	:	702-982-0079
Fax Number	:

Provider Business Practice Location Address
First Line	:	9310 SUN CITY BLVD
Second Line	:	SUITE 103
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-1705
Country	:	US
Telephone Number	:	702-982-0079
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FRANCHESTA MARBURY-HAMMONDS
Credential	:
Telephone Number	:	702-743-3726

Provider Enumeration Date	:	09/22/2015
Last Update Date	:	11/09/2015

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