MEDICARE: SOUTHERN HILLS PELVIC AND PHYSICAL THERAPY PLLC

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

General Provider Information

NPI Number	:	1255928693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HILLS PELVIC AND PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	9414 DEL WEBB BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-8314
Country	:	US
Telephone Number	:	702-331-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	5775 S FORT APACHE RD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5627
Country	:	US
Telephone Number	:	702-331-1654
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CLINIC DIRECTOR
Name	:	SHOSHANA IZKHAKOV
Credential	:
Telephone Number	:	631-388-8716

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	01/13/2021

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