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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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