Basic Information
Provider Information
NPI: 1366623266
EntityType: 2
ReplacementNPI:  
OrganizationName: REHAB & INDUSTRIAL SERVICES, LLP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: REHAB SERVICES OF NEVADA - LAS VEGAS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 HANSON ST
Address2:  
City: WINNEMUCCA
State: NV
PostalCode: 894453607
CountryCode: US
TelephoneNumber: 7756252222
FaxNumber: 7756251131
Practice Location
Address1: 5546 S FORT APACHE RD
Address2: SUITE 200
City: LAS VEGAS
State: NV
PostalCode: 891487692
CountryCode: US
TelephoneNumber: 7029479994
FaxNumber: 7029479998
Other Information
ProviderEnumerationDate: 11/19/2007
LastUpdateDate: 06/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: SNOW
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: J.
AuthorizedOfficialTitleorPosition: PARTNER
AuthorizedOfficialTelephone: 7756252222
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: REHAB & INDUSTRIAL SERVICES, LLP
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: DPT
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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