MEDICARE: MUTYA C. O'BOYLE P.T.

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	PT 2345	NV

General Provider Information

NPI Number	:	1740411263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUTYA C. O'BOYLE P.T.

Provider Business Mailing Address
First Line	:	3831 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1859
Country	:	US
Telephone Number	:	702-876-1733
Fax Number	:	702-878-2018

Provider Business Practice Location Address
First Line	:	4800 E BONANZA RD
Second Line	:	SUITE 2
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3470
Country	:	US
Telephone Number	:	702-438-3188
Fax Number	:	702-438-4550

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

Provider Enumeration Date	:	07/31/2009
Last Update Date	:	07/19/2022

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