MEDICARE: SUSAN PRIESTMAN

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0807	OTHER	NV	LICENSE #

General Provider Information

NPI Number	:	1699885335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PRIESTMAN

Provider Business Mailing Address
First Line	:	6575 N TIOGA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3539
Country	:	US
Telephone Number	:	702-373-6936
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 N MARTIN L KING BLVD
Second Line	:	SUITE 101A
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-3216
Country	:	US
Telephone Number	:	702-308-2998
Fax Number	:

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/07/2012

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Directions to “ SUSAN PRIESTMAN ” Practice Location

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