MEDICARE: MARCHANT PHYSICAL THERAPY & WELLNESS, INC.

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	174400000X	Specialist	78602	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205838265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARCHANT PHYSICAL THERAPY & WELLNESS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89024-0069
Country	:	US
Telephone Number	:	702-346-3105
Fax Number	:	703-346-3544

Provider Business Practice Location Address
First Line	:	340 FALCON RIDGE PARKWAY
Second Line	:	BUILDING 500
City	:	MESQUITE
State	:	NV
Zip	:	89027
Country	:	US
Telephone Number	:	702-346-3105
Fax Number	:	702-346-3544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BOBBY ISMAIL
Credential	:	DPT
Telephone Number	:	209-353-1988

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/06/2023

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