Organization
EXECUTIVE FITNESS INC
Active
Other names
TIM SODER PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE DICKINSON (OFFICE MANAGER)
(702) 222-1000
Entity
Organization
Contact information
Practice address
6440 MEDICAL CENTER ST STE 100, LAS VEGAS, NV 89148-2404
(702) 222-1000
(702) 222-9448
Mailing address
6440 MEDICAL CENTER ST STE 100, LAS VEGAS, NV 89148-2404
(702) 222-1000
(702) 222-9448
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2408
NV
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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