MEDICARE: MR. GARY C AMICK 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	225100000X	Physical Therapist	0223	NV

General Provider Information

NPI Number	:	1528107174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY C AMICK PT

Provider Business Mailing Address
First Line	:	3399 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3312
Country	:	US
Telephone Number	:	702-733-1842
Fax Number	:	702-732-4454

Provider Business Practice Location Address
First Line	:	3399 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3312
Country	:	US
Telephone Number	:	702-733-1842
Fax Number	:	702-732-4454

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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