Organization
PHASE 1 SPORTS PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK G HENNESS (OWNER)
(702) 683-8777
Entity
Organization
Contact information
Practice address
7770 DEAN MARTIN DR STE 307, LAS VEGAS, NV 89139-6603
(702) 641-0111
Mailing address
7770 DEAN MARTIN DR STE 307, LAS VEGAS, NV 89139-6603
(702) 641-0111
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
06/04/2020
Last updated
06/04/2020
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