Organization
SPORTS LLC
Active
Other names
FYZICAL SPORTS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHANIE HOLMSTROM (OFFICE ADMINISTRATOR)
(702) 655-8535
Entity
Organization
Contact information
Practice address
9070 W. CHEYENNE AVE, SUITE. #100, LAS VEGAS, NV 89129
(702) 655-8535
(702) 656-5863
Mailing address
9070 W. CHEYENNE AVE, STE. #100, LAS VEGAS, NV 89129
(702) 655-8535
(702) 656-5863
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
0449
NV
225100000X
Physical Therapist
2004
NV
225100000X
Physical Therapist
Primary
2005
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
V101520
MEDICARE GROUP
NV
Enumeration date
08/04/2006
Last updated
08/19/2016
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