MEDICARE: AGATHA ROSE NEGRE

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	4496	NV

General Provider Information

NPI Number	:	1760133391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGATHA ROSE NEGRE

Provider Business Mailing Address
First Line	:	2500 N RAINBOW BLVD APT 2061
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4545
Country	:	US
Telephone Number	:	646-923-1599
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 N RAINBOW BLVD APT 2061
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4545
Country	:	US
Telephone Number	:	646-923-1599
Fax Number	:

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

Provider Enumeration Date	:	01/14/2022
Last Update Date	:	01/14/2022

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Directions to “ AGATHA ROSE NEGRE ” Practice Location

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