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NPI Code Detail

MEDICARE: CHAYA S GREEN DPT

MEDICARE: CHAYA S GREEN DPT
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
1225100000XPhysical Therapist070.022522IL
2225100000XPhysical Therapist4726NV

General Provider Information

NPI Number : 1467803221
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHAYA S GREEN DPT
Provider Business Mailing Address
First Line : 8402 CENTENNIAL PKWY STE 240
Second Line :
City : LAS VEGAS
State : NV
Zip : 89149-4793
Country : US
Telephone Number : 702-294-7499
Fax Number : 702-294-7494
Provider Business Practice Location Address
First Line : 4370 BLUE DIAMOND RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89139-7787
Country : US
Telephone Number : 702-443-9301
Fax Number : 702-342-0600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2016
Last Update Date : 04/13/2023

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Directions to “ CHAYA S GREEN DPT” Practice Location

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