MEDICARE: NATASHA NICOLE DACALOS 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	6706	NV

General Provider Information

NPI Number	:	1881572030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA NICOLE DACALOS PT

Provider Business Mailing Address
First Line	:	7255 S TENAYA WAY STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2187
Country	:	US
Telephone Number	:	702-839-1114
Fax Number	:	702-380-1081

Provider Business Practice Location Address
First Line	:	7255 S TENAYA WAY STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2187
Country	:	US
Telephone Number	:	702-839-1114
Fax Number	:	702-380-1081

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

Provider Enumeration Date	:	08/25/2025
Last Update Date	:	08/25/2025

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