Provider Demographics
NPI:1104460450
Name:PHYSICAL THERAPY ON THE GO LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY ON THE GO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:NATALE
Authorized Official - Last Name:MADRASO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:775-440-3706
Mailing Address - Street 1:PO BOX 33296
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-3296
Mailing Address - Country:US
Mailing Address - Phone:775-440-3706
Mailing Address - Fax:775-204-9774
Practice Address - Street 1:10200 TIMBERWOLF DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9664
Practice Address - Country:US
Practice Address - Phone:775-440-3706
Practice Address - Fax:775-204-9774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6617247OtherAETNA