Organization
FAMILY AND SPORTS PHYSICAL THERAPY
Active
Organization
FAMILY AND SPORTS PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF DIETRICH PT (DIRECTOR, SECRETARY)
(702) 968-0520
Entity
Organization
Contact information
Practice address
7351 PRAIRIE FALCON RD STE 100, LAS VEGAS, NV 89128-0820
(702) 968-0520
(702) 968-0521
Mailing address
7351 PRAIRIE FALCON RD STE 100, LAS VEGAS, NV 89128-0820
(702) 968-0520
(702) 968-0521
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
10/26/2006
Last updated
04/21/2015
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