Organization
REDIRECT ATHLETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TISHA LAGRONE (OWNER)
(775) 870-9589
Entity
Organization
Contact information
Practice address
5655 RIGGINS CT STE 7, RENO, NV 89502-6565
(775) 870-9589
Mailing address
5655 RIGGINS CT STE 7, RENO, NV 89502-6565
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
—
Other
Enumeration date
11/30/2018
Last updated
11/30/2018
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