MEDICARE: THERAPY OF SOUTHERN NEVADA LLC

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	251S00000X	Community/Behavioral Health Agency

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	:	1821698556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAPY OF SOUTHERN NEVADA LLC

Provider Business Mailing Address
First Line	:	3340 TOPAZ ST STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3906
Country	:	US
Telephone Number	:	702-268-7604
Fax Number	:	702-442-8840

Provider Business Practice Location Address
First Line	:	3340 TOPAZ ST STE 170
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-3906
Country	:	US
Telephone Number	:	702-268-7604
Fax Number	:	702-442-8840

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOE WHITLEY JR.
Credential	:
Telephone Number	:	702-268-7604

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	04/21/2022

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