MEDICARE: JUNWYN THOMAS VALDEZ AGUSTIN PT

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	3057	NV

General Provider Information

NPI Number	:	1821492778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUNWYN THOMAS VALDEZ AGUSTIN PT

Provider Business Mailing Address
First Line	:	6028 LAMBERT BRIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7589
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6028 LAMBERT BRIDGE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-7589
Country	:	US
Telephone Number	:	586-381-8315
Fax Number	:

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

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	07/21/2015

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