MEDICARE: EMAD SANUOS 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
1	225100000X	Physical Therapist	043450	NY
2	225100000X	Physical Therapist	4590	NV

General Provider Information

NPI Number	:	1205310885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMAD SANUOS PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 W CHARLESTON BLVD STE 107
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1923
Country	:	US
Telephone Number	:	702-258-9381
Fax Number	:	702-258-9584

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	07/24/2023

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Directions to “ EMAD SANUOS PT” Practice Location

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