MEDICARE: LAS VEGAS REHABILITATION SERVICES

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	1217	NV

General Provider Information

NPI Number	:	1760711931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS VEGAS REHABILITATION SERVICES

Provider Business Mailing Address
First Line	:	1504 COUNTRY HOLLOW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6609
Country	:	US
Telephone Number	:	702-869-6714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 COUNTRY HOLLOW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-6609
Country	:	US
Telephone Number	:	702-869-6714
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CEFERINO VILLAFUERTE
Credential	:	P.T.
Telephone Number	:	702-498-4497

Provider Enumeration Date	:	12/16/2009
Last Update Date	:	12/16/2009

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