MEDICARE: ANCHAL BISEN 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	3484	NV

General Provider Information

NPI Number	:	1942748082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANCHAL BISEN PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2222
Fax Number	:	630-759-9510

Provider Business Practice Location Address
First Line	:	4000 S EASTERN AVE
Second Line	:	300
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-0824
Country	:	US
Telephone Number	:	702-734-2732
Fax Number	:	702-737-1453

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

Provider Enumeration Date	:	02/09/2017
Last Update Date	:	02/09/2017

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Directions to “ ANCHAL BISEN PT” Practice Location

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