# FUNCTIONAL NEURO REHAB, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023612066
- **Authorized official:** SHANNON MARIAH OLIVERO-CHEW O.T. (OWNER)
- **Authorized official phone:** (575) 479-7056

## Contact information

- **Practice address:** 650 WHITNEY RANCH DR APT 1511, HENDERSON, NV 89014-2615
- **Practice address phone:** (253) 261-8436
- **Mailing address:** 304 S JONES BLVD STE 3511, LAS VEGAS, NV 89107-2623
- **Mailing address phone:** (575) 479-7056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/30/2020
- **Last updated:** 09/06/2023