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
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.