Basic Information
| Provider Information | |||||||||
| NPI: | 1457544611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALWARDT | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7361 PRAIRIE FALCON RD | ||||||||
| Address2: | 130-B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022430515 | ||||||||
| FaxNumber: | 7022432019 | ||||||||
| Practice Location | |||||||||
| Address1: | 7361 PRAIRIE FALCON RD | ||||||||
| Address2: | 130-B | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022430515 | ||||||||
| FaxNumber: | 7022432019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1864 | NV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 100505757 | 05 | NV | MEDICAID |