MEDICARE: ALEJANDRO PRECIADO 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	3817	NV

General Provider Information

NPI Number	:	1699257691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO PRECIADO DPT

Provider Business Mailing Address
First Line	:	4128 HARDWICK CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-4419
Country	:	US
Telephone Number	:	928-246-9528
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 GRAND MONTECITO PKWY STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-0261
Country	:	US
Telephone Number	:	702-515-1540
Fax Number	:

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

Provider Enumeration Date	:	09/05/2018
Last Update Date	:	09/05/2018

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