MEDICARE: THI OF NEVADA AT DESERT VALLEY THERAPY

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	2071	NV

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	:	1992882054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THI OF NEVADA AT DESERT VALLEY THERAPY

Provider Business Mailing Address
First Line	:	1600 E ROCHELLE AVE
Second Line	:	APT 144
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5555
Country	:	US
Telephone Number	:	702-735-1501
Fax Number	:	702-735-1875

Provider Business Practice Location Address
First Line	:	2055 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3829
Country	:	US
Telephone Number	:	702-735-1501
Fax Number	:	702-735-1875

Authorized Official
Title or Position	:	STAFF PHYSICAL THERAPIST
Name	:	TORRE K SUMMONS
Credential	:	MSPT
Telephone Number	:	702-735-1501

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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