MEDICARE: MR. TREVOR A OFFENBACKER 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	1010	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770582462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TREVOR A OFFENBACKER P.T.

Provider Business Mailing Address
First Line	:	3602 E SUNSET RD
Second Line	:	LAS VEGAS
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-7202
Country	:	US
Telephone Number	:	702-932-4308
Fax Number	:	702-837-8930

Provider Business Practice Location Address
First Line	:	1420 E CALVADA BLVD
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89048-3974
Country	:	US
Telephone Number	:	775-727-4700
Fax Number	:	775-727-7970

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	03/05/2013

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