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NPI Code Detail

MEDICARE: MR. COREY WAYNE SOMERVILLE PT

MEDICARE: MR. COREY WAYNE SOMERVILLE PT
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
1225100000XPhysical Therapist5401SC
2225100000XPhysical TherapistPT018058PA
3225100000XPhysical Therapist2262NV

General Provider Information

NPI Number : 1164545562
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. COREY WAYNE SOMERVILLE PT
Provider Business Mailing Address
First Line : 4200 S VALLEY VIEW BLVD
Second Line : #3092
City : LAS VEGAS
State : NV
Zip : 89103-4029
Country : US
Telephone Number : 570-371-7088
Fax Number :
Provider Business Practice Location Address
First Line : 4200 S VALLEY VIEW BLVD
Second Line : #3092
City : LAS VEGAS
State : NV
Zip : 89103-4029
Country : US
Telephone Number : 570-371-7088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 11/14/2012

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