MEDICARE: DESERT VALLEY THERAPY

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	261QP2000X	Physical Therapy Clinic/Center	2911	NV

General Provider Information

NPI Number	:	1316378920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT VALLEY THERAPY

Provider Business Mailing Address
First Line	:	2851 N TENAYA WAY
Second Line	:	SUITE 205
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0435
Country	:	US
Telephone Number	:	702-655-9456
Fax Number	:	702-655-9594

Provider Business Practice Location Address
First Line	:	2851 N TENAYA WAY
Second Line	:	SUITE 205
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0435
Country	:	US
Telephone Number	:	702-655-9456
Fax Number	:	702-655-9456

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	LIZ MILLER
Credential	:
Telephone Number	:	702-605-9080

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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Directions to “DESERT VALLEY THERAPY ” Practice Location

Language	Start Address	Practice Location

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