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NPI Code Detail

MEDICARE: MR. TIMOTHY BRIAN SODER MSPT

MEDICARE:  MR. TIMOTHY BRIAN SODER  MSPT
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 Therapist0714NV

General Provider Information

NPI Number : 1174648935
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TIMOTHY BRIAN SODER MSPT
Provider Business Mailing Address
First Line : 6440 MEDICAL CENTER ST
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Provider Business Practice Location Address
First Line : 6440 MEDICAL CENTER ST
Second Line : #100
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2007
Last Update Date : 06/05/2009

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Directions to “ MR. TIMOTHY BRIAN SODER MSPT” Practice Location

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