MEDICARE: MR. JAMES JOSHUA GREATHOUSE DPT

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	2408	NV

General Provider Information

NPI Number	:	1205167517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES JOSHUA GREATHOUSE DPT

Provider Business Mailing Address
First Line	:	6440 MEDICAL CENTER ST STE 100
Second Line	:
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	:	1845 VILLAGE CENTER CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134
Country	:	US
Telephone Number	:	702-723-9006
Fax Number	:	702-664-0466

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2010
Last Update Date	:	03/17/2018

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