MEDICARE: KEITH PAOLO MAQUILING PTA

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	225200000X	Physical Therapy Assistant	A-1720	NV

General Provider Information

NPI Number	:	1871354464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH PAOLO MAQUILING PTA

Provider Business Mailing Address
First Line	:	9604 MARIGNY CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7850
Country	:	US
Telephone Number	:	916-579-9668
Fax Number	:

Provider Business Practice Location Address
First Line	:	3870 W ANN RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-4411
Country	:	US
Telephone Number	:	916-579-9668
Fax Number	:

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

Provider Enumeration Date	:	01/19/2024
Last Update Date	:	09/03/2025

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Directions to “ KEITH PAOLO MAQUILING PTA” Practice Location

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