MEDICARE: REBECCA L PRIVITT PT

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	2039	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	:	1497734503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L PRIVITT PT

Provider Business Mailing Address
First Line	:	8561 W FISHER AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-4057
Country	:	US
Telephone Number	:	702-545-0265
Fax Number	:	928-771-9519

Provider Business Practice Location Address
First Line	:	4765 S DURANGO DR
Second Line	:	SUITE #106
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-8145
Country	:	US
Telephone Number	:	702-898-7633
Fax Number	:	927-881-9519

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	07/08/2007

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