MEDICARE: MRS. LAUREN DINICOLA PHYSICAL THERAPIST,

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	2253	NV

General Provider Information

NPI Number	:	1679729537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN DINICOLA PHYSICAL THERAPIST,

Provider Business Mailing Address
First Line	:	3650 S. EASTERN AVENUE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-731-6873
Fax Number	:	702-731-2565

Provider Business Practice Location Address
First Line	:	3650 S. EASTERN AVENUE
Second Line	:	SUITE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-3345
Country	:	US
Telephone Number	:	702-731-6873
Fax Number	:	702-731-2565

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/16/2009

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