MEDICARE: DR. GREGORY MANUEL AMAYA PT, 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
1	225100000X	Physical Therapist	4012	NV

General Provider Information

NPI Number	:	1609435460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY MANUEL AMAYA PT, DPT

Provider Business Mailing Address
First Line	:	4255 TAMARUS ST APT 244
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5712
Country	:	US
Telephone Number	:	760-238-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CRAIG RD STE 210
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-0327
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

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

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/06/2019

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