MEDICARE: APICHAI HAISUPA MPT

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	1309	NV

General Provider Information

NPI Number	:	1538113121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	APICHAI HAISUPA MPT

Provider Business Mailing Address
First Line	:	4104 RUBICON PEAK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-3673
Country	:	US
Telephone Number	:	702-656-2117
Fax Number	:

Provider Business Practice Location Address
First Line	:	2851 N TENAYA WAY
Second Line	:	SUITE 205
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0453
Country	:	US
Telephone Number	:	702-655-9456
Fax Number	:	702-655-9594

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	07/08/2007

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Directions to “ APICHAI HAISUPA MPT” Practice Location

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