MEDICARE: ANDREA AVRUSKIN 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	1223NV	NV
2	2255A2300X	Athletic Trainer	0506088	NV

General Provider Information

NPI Number	:	1568621092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA AVRUSKIN PT

Provider Business Mailing Address
First Line	:	600 S TONOPAH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4025
Country	:	US
Telephone Number	:	702-380-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S TONOPAH DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4025
Country	:	US
Telephone Number	:	702-380-0671
Fax Number	:

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

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	05/01/2013

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