Provider Demographics
NPI:1194062877
Name:TABOR, ANTHONY (DPT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:TABOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 S JONES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2228
Mailing Address - Country:US
Mailing Address - Phone:702-731-0831
Mailing Address - Fax:
Practice Address - Street 1:6480 S TENAYA WAY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6655
Practice Address - Country:US
Practice Address - Phone:702-623-8555
Practice Address - Fax:702-623-8545
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic