Individual
KRISTIN MARIE MACCANICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2150 S EASTERN AVE, LAS VEGAS, NV 89104-4109
(702) 207-0842
(702) 207-0357
Mailing address
2150 S EASTERN AVE, LAS VEGAS, NV 89104-4109
(702) 207-0842
(702) 207-0357
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
8183
MA
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
06/02/2011
Last updated
10/18/2025
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