Organization
GREAT BASIN PHYSICAL THERAPY AND PERFORMANCE CENTER
Active
Organization
GREAT BASIN PHYSICAL THERAPY AND PERFORMANCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHWIN T DATT PT (SOLE MEMBER)
(831) 238-5217
Entity
Organization
Contact information
Practice address
1701 COUNTY RD, SUITE B, MINDEN, NV 89423-4464
(775) 782-4466
Mailing address
PO BOX 34120, RENO, NV 89533-4120
(775) 747-5050
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2193
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2193
BOARD OF PHYSICAL THERAPY EXAMINERS
NV
01
—
34615
PHYSICAL THERAPY BOARD OF CALIFORNIA
CA
Enumeration date
04/30/2010
Last updated
09/03/2015
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