MEDICARE: MML PHYSICAL THERAPY GROUP 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	225100000X	Physical Therapist	0675	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	:	1427379148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MML PHYSICAL THERAPY GROUP INC

Provider Business Mailing Address
First Line	:	600 S TONOPAH DR
Second Line	:	SUITE 350
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4025
Country	:	US
Telephone Number	:	702-384-6330
Fax Number	:	702-384-2668

Provider Business Practice Location Address
First Line	:	600 S TONOPAH DR
Second Line	:	SUITE 350
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4025
Country	:	US
Telephone Number	:	702-384-6330
Fax Number	:	702-384-2668

Authorized Official
Title or Position	:	OWNER
Name	:	KAREN CRAWFORD
Credential	:	PT
Telephone Number	:	702-384-6330

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	10/24/2016

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