MEDICARE: MR. TOLUPENI ADILIE SALIMA JR.

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	2822	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2822	OTHER	NV	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1700200672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TOLUPENI ADILIE SALIMA JR.

Provider Business Mailing Address
First Line	:	4080 N MARTIN L KING BLVD
Second Line	:	SUITE 101A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3216
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 N MARTIN L KING BLVD
Second Line	:	SUITE 101A
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-3216
Country	:	US
Telephone Number	:	702-360-9142
Fax Number	:

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

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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