MEDICARE: ERIKA LEE CISAN

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	1713	NV

General Provider Information

NPI Number	:	1730220385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA LEE CISAN

Provider Business Mailing Address
First Line	:	4220 FAIRYWREN DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3735
Country	:	US
Telephone Number	:	702-544-4008
Fax Number	:

Provider Business Practice Location Address
First Line	:	4220 FAIRYWREN DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-3735
Country	:	US
Telephone Number	:	702-544-4008
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	10/15/2024

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