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NPI Code Detail

MEDICARE: BRODERICK A BRASS DPT

MEDICARE: BRODERICK A BRASS 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 Therapist3777NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13777OTHERNVNV STATE LICENSE

General Provider Information

NPI Number : 1538649025
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRODERICK A BRASS DPT
Provider Business Mailing Address
First Line : 6440 MEDICAL CENTER ST STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Provider Business Practice Location Address
First Line : 6440 MEDICAL CENTER ST STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2018
Last Update Date : 08/15/2018

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Directions to “ BRODERICK A BRASS DPT” Practice Location

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