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NPI Code Detail

MEDICARE: EXECUTIVE FITNESS INC

MEDICARE: EXECUTIVE FITNESS INC
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
1225100000XPhysical Therapist1000002-322NV

General Provider Information

NPI Number : 1881710192
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXECUTIVE FITNESS INC
Provider Business Mailing Address
First Line : 6440 MEDICAL CENTER ST STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Provider Business Practice Location Address
First Line : 6440 MEDICAL CENTER ST
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89148-2404
Country : US
Telephone Number : 702-222-1000
Fax Number : 702-222-9448
Authorized Official
Title or Position : DIRECTOR
Name : MR. TIMOTHY BRIAN SODER
Credential : MSPT
Telephone Number : 702-222-1000
Provider Enumeration Date : 03/21/2007
Last Update Date : 01/09/2008

Similar Medicare Providers

1174648935 — MR. TIMOTHY BRIAN SODER MSPT
Practice Location Address:
6440 MEDICAL CENTER ST , #100
LAS VEGAS, NV
89148-2404
Practice Phone: 702-222-1000
Practice Fax: 702-222-9448
1992951610 — MR. MATTHEW GREENBERG DPT
Practice Location Address:
6440 MEDICAL CENTER ST STE 100
LAS VEGAS, NV
89148-2404
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1639326820 — MR. MATTHEW PAUL WYLUBSKI PT/DPT
Practice Location Address:
6440 MEDICAL CENTER ST , SUITE 100
LAS VEGAS, NV
89148-2404
Practice Phone: 702-222-1000
Practice Fax:
1144552316 — EXECUTIVE FITNESS INC
Practice Location Address:
6440 MEDICAL CENTER ST STE 100
LAS VEGAS, NV
89148-2404
Practice Phone: 702-222-1000
Practice Fax: 702-222-9448
1013422088 — KARLO B ARCIAGA DPT
Practice Location Address:
6440 MEDICAL CENTER ST STE 100
LAS VEGAS, NV
89148-2404
Practice Phone: 702-222-1000
Practice Fax: 702-222-9448
1538649025 — BRODERICK A BRASS DPT
Practice Location Address:
6440 MEDICAL CENTER ST STE 100
LAS VEGAS, NV
89148-2404
Practice Phone: 702-222-1000
Practice Fax: 702-222-9448

Directions to “EXECUTIVE FITNESS INC ” Practice Location

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