MEDICARE: ON THE ROLL PT, LLC

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

General Provider Information

NPI Number	:	1528736295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ON THE ROLL PT, LLC

Provider Business Mailing Address
First Line	:	1541 VIA CASSIA
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4122
Country	:	US
Telephone Number	:	402-960-6719
Fax Number	:

Provider Business Practice Location Address
First Line	:	10462 VIOLET PEARL ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7986
Country	:	US
Telephone Number	:	323-553-7655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KIRA MARKUS
Credential	:	DPT
Telephone Number	:	402-960-6719

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	08/30/2021

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Directions to “ON THE ROLL PT, LLC ” Practice Location

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