# GOLD STAR PHYSICAL THERAPY LLC

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

## Provider details

- **NPI number:** 1336735687
- **Authorized official:** FAYNELLA MARIE TIU PT (OWNER)
- **Authorized official phone:** (314) 629-2150

## Contact information

- **Practice address:** 2651 CRIMSON CANYON DR STE 120, LAS VEGAS, NV 89128-0843
- **Practice address phone:** (314) 629-2150
- **Mailing address:** 2651 CRIMSON CANYON DR STE 120, LAS VEGAS, NV 89128-0843

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2251C2600X | Cardiopulmonary Physical Therapist | — | NULL | Yes |
| 2251C2600X | Cardiopulmonary Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 12/21/2020
- **Last updated:** 01/19/2021